Docstoc

242

Document Sample
242 Powered By Docstoc
					                                                  Hospital
Center for HICS Education and Training



                                         Incident Command System
                                           Train-The-Trainer Course
                                         Course Expectations
Center for HICS Education and Training




                                         Why are you here today?
                                                  Course Objectives
Center for HICS Education and Training


                                         • Outline the historical development of HEICS
                                           and HICS
                                         • Learn the principles and concepts from IS
                                           700, ICS 100 & 200
                                         • Discuss NIMS Implementation Activities for
                                           hospitals
                                         • Learn the principal concepts and features of
                                           HICS
                                                  Course Objectives
Center for HICS Education and Training
                                                                              (2)




                                         • Understand the roles and relationships of the
                                           Incident Management Team
                                         • Understand the application and use of the
                                           HICS elements
                                         • Conduct a facilitated, scenario-based exercise
                                         • Discuss train-the-trainer strategies for
                                           implementing and teaching HICS
Center for HICS Education and Training             This course is presented by:
                                                     The Center for HICS
                                                    Education and Training
                                         • The Center is a collaborative effort between the ER 1
                                           Institute at Washington Hospital Center and Kaiser
                                           Permanente
                                         • Our mission is to provide information, education and
                                           training on HICS
                                         • The Center’s Advisory Board consists of National
                                           Workgroup and Ex-officio members from the HEICS 4
                                           project
                                         • The Center sponsors a webpage for additional info and
                                           updates on HICS utilization at www.hicscenter.org
Center for HICS Education and Training




              Title
                         Name
           Association
                                   Course Faculty
Center for HICS Education and Training
                                                       Housekeeping Notes
                                         • All technology to “silent” or “vibrate” please
                                         • If you must take or make a call
                                            – Wait for a break
                                            – Leave the room for calls
                                         • We will have regular breaks during the course
                                            – Please stay within the announced break times
                                         • Restroom location(s)
                                         • Emergency exits
                                         • There will be time for Q&A- save your questions to
                                           the announced periods
                                         • Please consult with the instructors during breaks if
                                           needed
                                         • Your evaluations are important to us! Complete the
                                           evaluation form by the end of the day!
                                                   Course Copyright
Center for HICS Education and Training



                                         • The HICS course materials are proprietary
                                           and cannot be duplicated, reproduced or
                                           utilized without written permission of The
                                           Center
                                         • No cameras or video taping or recording of
                                           this program are permitted
                                               HICS Course Structure
Center for HICS Education and Training



                                         • Review of agenda

                                         • Post Test on Day 2
                                           – HICS course completion
                                           – ICS 100 & 200 HC, IS 700 course completion


                                         • On the presentation:
                                           – Items on the post-test are indicated by **
                                           – Key NIMS/ICS concepts are noted by *
Center for HICS Education and Training




                                         Emergency Response
                                                Is Not
                                          Business as Usual !
Center for HICS Education and Training
                                               What is the Hospital Goal?
                                         • Preparedness
                                           – Develop effective Emergency Management and
                                             Operations Plans
                                         • Response
                                           – Ensure safety of patients, personnel and facility
                                           – Triage, treat, transfer and disposition victims
                                           – Ensure business continuity
                                         • Recovery
                                           – Operational/Business Recovery
                                           – Financial recovery
                                           – Restoration of “normal” operations
Center for HICS Education and Training


                                              The Incident
                                            Command System

                                               ICS 100 and 200
                                         For Health Care Organizations
                                           Incident Command System
Center for HICS Education and Training



                                         • This section provides ICS 100 and 200 HC
                                           course concepts and principles
                                         • The ICS course is designed to meet the all-
                                           hazard, multi-agency NIMS ICS requirement
                                           for operational personnel
                                         • ICS enables personnel to operate efficiently
                                           during an incident
                                           Incident Command System
Center for HICS Education and Training


                                         • Adopting ICS in hospitals has many benefits:
                                           – Greater efficiency to manage internal and
                                             external incidents
                                           – Better coordination with outside agencies
                                           – Improved communications with agencies using
                                             common terminology and position titles
                                           – Provides a standardized, all-hazard incident
                                             management tool
                                           – Comply with the Joint Commission standard to
                                             utilize an ICS consistent with community use
                                                   History of ICS
Center for HICS Education and Training


                                         • ICS developed in response to
                                           California wildfires in the 1970s
                                         • Major response problems were identified
                                           – Lack of a effective management structure
                                           – Lack of accountability and clear chain of command
                                           – Poor communications
                                           – Lack of systematic planning
                                           – No integration of agencies into management
                                             structure and planning
                                                       History of ICS
Center for HICS Education and Training



                                         • ICS is built on best practices
                                           – Successful use in military and business practices
                                           – Lessons learned in response to incidents
                                           – Use in all levels of government and private sector
                                         • NIMS requires the use of ICS
                                           – Federal agencies are required to adopt NIMS,
                                             state and local jurisdictions and hospitals are
                                             required to be NIMS compliant as a condition for
                                             receiving Federal preparedness grant dollars.
                                                      Purpose of ICS
Center for HICS Education and Training


                                         • An interdisciplinary and flexible tool
                                         • Adaptable to incident of any kind or size**
                                           – Scalable activation
                                         • Standardized to integrate other agencies and
                                           organizations into the management
                                           structure**
                                         • Provide a logistical and administrative
                                           support to operational staff**
                                         • Be cost effective by avoiding duplication**
                                         • For use in planned events and incidents**
                                                         ICS Features
Center for HICS Education and Training


                                         •   Common terminology/clear text
                                         •   Modular organization
                                         •   Management by objectives
                                         •   Incident Action Planning
                                         •   Manageable span of control
                                         •   Pre-designated incident locations/facilities
                                         •   Resource management
                                         •   Integrated communications
                                         •   Common command structure
                                              Common Terminology**
Center for HICS Education and Training


                                         • Use clear text – plain English
                                           – No radio codes
                                           – No organization specific codes
                                              o Use of Hospital Codes (i.e., Code Blue) are ok even
                                                though they do not comply with ICS; plain language
                                                should be used when communicating to external
                                                agencies.
                                           – No jargon
                                                Common Terminology
Center for HICS Education and Training


                                         • Helps to define:
                                           – Organizational functions
                                              o Major functions and units named and defined
                                                 – Example: Command, Operations, Planning, etc.
                                           – Resource descriptions
                                              o Major personnel, facilities and equipment/supplies are
                                                named or “typed” by capability
                                           – Incident facilities
                                              o Common names for designated incident facilities (i.e.,
                                                EOC)
                                           – Position titles: Officer, Chief, Director, etc.
                                                Modular Organization
Center for HICS Education and Training



                                         • ICS structure develops from the top down
                                         • Positions activated as dictated by the incident
                                           size or complexity
                                         • As complexity increases, the ICS organization
                                           expands
                                         • Only those functions or positions necessary
                                           for an incident are activated
                                           Management by Objectives
Center for HICS Education and Training


                                         • ICS Implemented
                                         • Initial Incident Commander Identified
                                           – The Incident Commander initiates the response
                                             and response objectives
                                         • Incident action planning steps
                                           – Understand organization policy and direction
                                           – Assess the incident situation
                                           – Establish incident objectives
                                           – Select strategies to achieve objectives
                                           – Perform tactical direction
                                           – Provide necessary follow up
                                             IAP - Operational Periods
Center for HICS Education and Training


                                         • An operational period is:
                                           – The period of time scheduled for execution of a
                                             given set of tactical actions in the IAP
                                           – Set by the Incident Commander, based on the
                                             incident
                                         • The operational period is usually set in hours
                                           – Does not have to conform to shift times
                                           – Can be long or short, depending on the intensity
                                             of the incident
Center for HICS Education and Training           Incident Action Plan
                                         • Purpose of the IAP
                                           – Provide personnel with direction for taking
                                             actions based on the objectives identified in the
                                             IAP**
                                           – Reflects the overall strategy for incident
                                             management
                                           – Provides measurable strategic operations for the
                                             operational period**
                                         • Can be oral or written
                                           – Written plans are more effective and provide a
                                             written record of expectations and actions taken
Center for HICS Education and Training
                                                 Incident Action Plan
                                         • Incident Action Planning through
                                           Management by Objectives
                                           – Setting the operational period
                                           – Determining overall priorities
                                           – Establishing specific measurable and attainable
                                             objectives
                                           – Setting strategies and tactics for the objectives
                                           – Identifying needed resources
                                           – Issuing assignments
                                           – Monitoring and evaluating efforts
                                           – Documenting results
                                                          Span of Control
Center for HICS Education and Training

                                         • Defined:
                                           – The number of individuals or resources one supervisor can
                                             manage effectively**
                                           – Is accomplished by organizing resources into Sections,
                                             Branches, Groups, Divisions and Teams**
                                         • Recommended span is 1:5 supervisor/reports**
                                           – Span of Control is key to effective and efficient incident
                                             management
                                           – Ratios may vary from 3 to 7 supervisor/reports
                                           – If the number falls outside these ratios
                                              o Expand or consolidate the organization
                                              o Exceptions in low risk assignments or resources in close proximity
Center for HICS Education and Training
                                                   Incident Facilities
                                         • Incident Command Post
                                           – Location where the IC oversees all incident
                                             operations
                                         • Staging areas
                                           – Temporary locations where resources are
                                             available and waiting for assignment**
                                             o Hospital Labor Pool is a staging area
                                         • Helibase
                                           – Location for management of helicopter operations
                                           – Designed by the name of the incident (i.e. ‘Mount
                                             Diablo’ Wildfire Helibase)
                                                    Incident Facilities
Center for HICS Education and Training



                                         • Helispots
                                           – Fixed or temporary areas where
                                             helicopters can land and take off
                                           – Pre-constructed location
                                           – Multiple helispots can be used


                                         • Emergency Operations Center
                                           – A multi-agency coordination center
                                              o Provides support and coordination for on-scene
                                                facilities
                                               Resource Management
Center for HICS Education and Training


                                         • Tactical resources
                                           – Personnel and major equipment available or
                                             potentially available to Operations**
                                              o Assigned: working under a supervisor
                                              o Available: assembled and ready for assignment
                                              o Out-of-service: not ready or available
                                         • Support resources
                                           – All other resources to support the incident
                                              o Food, communications, equipment, supplies, vehicles,
                                                etc.
                                              Resource Management
Center for HICS Education and Training


                                         • Includes processes for:
                                           – Establishing the resource needs
                                              o What kind?
                                              o What type?
                                              o How many?
                                           – Ordering resources
                                           – Dispatching, utilizing and evaluating resources
                                           – Tracking resources
                                           – Resource demobilization and recovery
                                           – Reimbursement for resources, as appropriate
                                          Integrated Communications
Center for HICS Education and Training


                                         • Three elements
                                           – Modes:
                                             o The hardware systems that transfer information
                                             o Can include radios, cell phones, pagers, email etc.
                                           – Planning:
                                             o Plans for use of all available communications resources
                                             o Development of a communications plan
                                           – Networks:
                                             o The procedures and processes for transferring
                                               information internally and externally
Center for HICS Education and Training
                                                          Command
                                         • Chain of command
                                           – An orderly line of authority within the
                                             management structure
                                         • Unity of command**
                                           – Every individual is accountable and reports to
                                             only one supervisor
                                                        Command
Center for HICS Education and Training



                                         • Single command
                                           – The Incident Commander has complete
                                             responsibility for the management
                                         • Unified command**
                                           – Shared incident management among responding
                                             agencies or organizations
Center for HICS Education and Training
                                                           Command
                                         • Transfer of command
                                           – Moving the responsibility from one incident
                                             commander to another
                                           – Occurs when
                                             o A more qualified person assumes command**
                                             o It is necessary for effectiveness or efficiency**
                                             o Incident complexity changes**
                                             o Shift change/turnover of staff**
                                             o Incident is concluded and responsibility returns to
                                               home agency
                                           – May be oral, written, or a combination of both
                                             transfer of command briefing
                                            Information Management
Center for HICS Education and Training


                                         • A process must be established for:
                                           – Gathering information
                                           – Sharing information
                                           – Managing incident-related information and
                                             intelligence
                                         • Information may come from multiple sources
                                           – Some information may be sensitive and cannot
                                             be shared**
                                           – Some information may be shared on a limited
                                             basis (i.e., demographic info only)
                                          Information and Intelligence
Center for HICS Education and Training


                                         • Based on the incident needs, the Information
                                           and Intelligence function may
                                           – Be shifted from the Planning Section
                                           – Information and Intelligence function may
                                             become a separate ICS position
                                             o A fifth General staff position**
                                             o Within the Command Staff**
                                             o As a separate Unit within the Planning Section**
                                             o As a Branch within Operations**
                                             Formal Communications
Center for HICS Education and Training



                                         • Formal Communications
                                           – Follows the lines of authority
                                           – Can be passed horizontally or vertically within the
                                             organization
                                         • Formal communications used when
                                           – Receiving and giving work assignments
                                           – Requesting support or additional resources
                                           – Reporting progress of assigned tasks**
                                            Informal Communications
Center for HICS Education and Training



                                         • Informal communications
                                           – Is used to exchange incident or event information
                                             only
                                           – Is NOT used for:
                                             o Formal request for additional resources
                                             o Tasking work assignments
                                            Personnel Responsibilities
Center for HICS Education and Training



                                         • Prepare for lengthy assignments
                                           – Self and family preparedness at home
                                         • Understand your role and responsibilities
                                           during an emergency
                                           – Review your assignment JAS
                                           – Know who you report to
                                           – Understand your decision-making authority
                                              o Including purchase authority
                                           – Establish communication procedures
                                            Personnel Responsibilities
Center for HICS Education and Training



                                         • Check in at the hospital
                                           – Check in officially logs you “in” at the incident
                                           – Check in process helps to
                                              o Logs you in as a responder
                                              o Ensure personnel accountability**
                                              o Track resources**
                                              o Prepare personnel for assignments/reassignment**
                                              o Locate personnel in emergency**
                                              o Organize the demobilization process**
                                           – Check in only once per shift!
                                            Personnel Responsibilities
Center for HICS Education and Training


                                         • After check in:
                                           – Locate your supervisor**
                                           – Receive your initial briefing**
                                              o Situation assess
                                              o Role and responsibilities
                                              o Safety procedures

                                         • Recordkeeping is critical
                                           – Complete all forms– print or type for legibility
                                           – Date, time and initial all forms
Center for HICS Education and Training
                                            Personnel Responsibilities
                                         • Communications
                                           – Plain English – no jargon or codes
                                           – Limit radio traffic
                                         • Personal conduct
                                           – In a highly stressful situation, ensure your
                                             interactions are professional and patient
                                         • Demobilization
                                           – When demobilized
                                              o Complete all assignments, forms and documents
                                              o Brief replacements
                                              o Return equipment and supplies
                                              o Complete post-incident reports/critiques/evaluations
Center for HICS Education and Training
                                           Leadership Responsibilities
                                         • Common leadership responsibilities
                                           – Ensures safe work practices** (Priority #1)
                                           – Takes command of assigned resources
                                           – Motivates with a “can do safely” attitude
                                           – Demonstrates initiative by taking action
                                           – Communicates critical information
                                             o Brief others as needed
                                             o Debrief their actions
                                             o Communicate hazards
                                             o Acknowledge messages
                                             o Ask if they do not know
                                             o If possible, communicate face-to-face
                                           Leadership Responsibilities
Center for HICS Education and Training



                                         • An effective leader:
                                           – Communicates with specific instructions
                                           – Asks for feedback
                                           – Supervises the scene of action
                                           – Evaluates the effectiveness of the plan
                                           – Understands and accepts the need to modify
                                             plans or instructions
                                           – Assesses and evaluates response and recovery
                                             post-incident
                                           – Contributes to corrective action planning
                                                 Leadership and Duty
Center for HICS Education and Training



                                         • Leaders should try to:
                                           – Take charge within your scope of authority
                                           – Be prepared to step out of a tactical role to
                                             assume a leadership role
                                           – Be proficient in your job
                                           – Make sound and timely decisions
                                           – Ensure tasks are understood
                                           – Develop subordinates for the future
                                              Leadership and Respect
Center for HICS Education and Training


                                         • Know your subordinates and look out for
                                           their well-being
                                         • Keep your subordinates and supervisor
                                           informed
                                         • Build the team
                                           – Frequent briefings and debriefings
                                           – Monitor progress and lessons learned
                                           – Consider team experience, fatigue and physical
                                             limitations
                                                      ICS Structure
Center for HICS Education and Training


                                         • The ICS organizational structure should
                                           include ONLY the functions and positions
                                           needed to achieve the incident objectives**
                                         • Five management functions
                                           – Incident command
                                           – Operations
                                           – Planning
                                           – Logistics
                                           – Finance/Administration
                                                   ICS Position Titles
Center for HICS Education and Training


                                         • Titles provide a common standard between
                                           agencies
                                           – Allows for filling ICS positions with the most
                                             qualified person rather than by seniority
                                           – Assists with requesting qualified persons
                                                Incident Commander
Center for HICS Education and Training




                                         • IC is the only position ALWAYS staffed**
                                         • Has overall responsibility for managing the
                                           entire incident
                                         • The IC oversees incident operations in the
                                           Incident Command Post (Hospital Command
                                           Center)**
                                             IC and Agency Executive
Center for HICS Education and Training


                                         • The IC commands the incident but
                                           periodically communicates to the agency
                                           executive (CEO)




                                         • The Agency Executive and EOP is responsible
                                           for establishing overall priorities and
                                           delegating authority to the IC to manage the
                                           incident**
                                                 Incident Commander
Center for HICS Education and Training

                                         • The IC may appoint one or more deputies
                                         • The IC should be the most qualified and trained
                                           person
                                           – Not appointed by rank, grade, or seniority

                                         • The IC is responsible until the authority is delegated
                                           to another person**
                                         • Formal transfer of command includes:
                                           – Command briefing for incoming IC
                                           – Notification to all personnel of the effective time and date
                                             of the change in command**
                                           – Demobilization of the out-going IC to avoid confusion**
Center for HICS Education and Training
                                   Expanding the ICS Organization
Center for HICS Education and Training
                                                     Command Staff**
                                         • Command Staff include
                                           – Public Information Officer
                                           – Safety Officer
                                           – Liaison Officer
                                                       General Staff**
                                         • General Staff include
                                           – Operations Section Chief
                                           – Logistics Section Chief
                                           – Planning Section Chief
                                           – Finance/Administration Section Chief
                                             These positions are detailed later in the course
                                               The Role of Deputies*
Center for HICS Education and Training



                                         • The IC, Command Staff, General Staff and
                                           Branch Directors may appoint a Deputy**
                                         • The Deputy may:
                                           – Assume responsibility for a specific portion of the
                                             primary work
                                           – Work as relief
                                           – Be assigned other tasks
                                         • The appointed Deputy should be as proficient
                                           as the person in the position
Center for HICS Education and Training



                                               Applying ICS
                                                    To
                                         Healthcare Organizations
Center for HICS Education and Training       Comprehensive Emergency
                                                  Management
                                         • A comprehensive emergency management
                                           program
                                           – Addresses all hazards
                                           – Uses the four phases
                                             o Mitigation (includes prevention)
                                             o Preparedness (includes planning, training, exercising)
                                             o Response
                                             o Recovery
                                         • ICS can be utilized in all phases
                                         • Required by the Joint Commission since 2001
Center for HICS Education and Training
                                                Integrated Emergency
                                                 Management System
                                         • IEMS was created by FEMA in 1983
                                           – Describes how CEMs are developed
                                         • Key directions
                                           – Emergency Management Program (EMP)
                                             development is a multi-year process
                                           – Emergency Operations Plans (EOP) based on
                                             functions, not hazards or agencies
                                                  Developing an EMP
Center for HICS Education and Training


                                         • Steps to develop an EMP
                                           – Hazards Vulnerability Analysis
                                           – Capability assessment
                                           – Emergency Operations Planning
                                           – Capability maintenance
                                           – Mitigation efforts
                                           – Emergency operations or exercises
                                           – Evaluation
                                           – Capability shortfall or gap analysis
                                           – Multi-year development planning
Center for HICS Education and Training
                                          Emergency Operations Plans
                                         • Written for “all-hazards”**
                                         • Contains 3 sections
                                           – Basic Plan
                                              o Overview of how the agency will organize and
                                                coordinate response and recovery activities
                                           – Functional Annexes
                                              o AKA - Emergency Support Functions
                                              o Explain how specific functions will be organized or
                                                implemented (i.e., Command, Operations, etc.)
                                           – Incident Specific Appendices
                                              o Short, concise guidance on response to priority
                                                hazards from the HVA
                                               Lifecycle of an Incident
Center for HICS Education and Training


                                         • Event recognition: when the organization is
                                           aware of the incident
                                         • Notifications of key staff and activation of
                                           EOP and ICS
                                         • Mobilization and assignment of staff for ICS
                                           positions
                                           – Incident-specific guides can facilitate mobilization
                                         • Incident Operations: are managed through
                                           the ICS organization
                                           – Incident Action Planning is key
                                              Lifecycle of an Incident
Center for HICS Education and Training



                                         • Demobilization of some or all of the ICS
                                           positions to meet incident needs
                                         • Transition to long-term recovery activities
                                           – Returning to “normal” organizational structure
                                         • Return-to-readiness activities
                                           – Post incident debriefing and critique
                                           – Action-action review and reporting
                                           – Corrective action planning and activities
                                               Situation Assessments
Center for HICS Education and Training


                                         • The Incident Commander conducts the
                                           assessment
                                           – Type of incident, location, magnitude, possible
                                             duration
                                           – On-going hazards and safety concerns
                                           – Determine initial priorities based on:
                                             o #1– Life saving
                                             o #2– Incident stabilization
                                             o #3– Property preservation
                                           – Location of the Incident Command Post
                                                 Incident Objectives
Center for HICS Education and Training



                                         • Incident Objectives must be:
                                           – Specific of what is to be done
                                           – Measurable (a standard and a timeframe)
                                           – Attainable and reasonable
                                           – In accordance with the IC authorities
                                           – Evaluated for effectiveness
Center for HICS Education and Training
                                                           ICS Tools
                                         • ICS Forms
                                           – Purpose of the form
                                           – Preparation: Who is responsible to complete the
                                             form?
                                           – Distribution: Who receives the form?
                                         • Position Description and Responsibilities
                                           document (i.e., Job Action Sheets)
                                         • Emergency Operations Plan
                                         • Organization Policies and Procedures
                                         • Maps
                                           ICS Management Processes
Center for HICS Education and Training



                                         • During each operational period, there are 6
                                           ICS management processes
                                           – Situation briefing and shift change
                                           – Management meetings
                                           – Planning meetings
                                           – Operations briefing
                                           – Implementation
                                           – Assessment of situation and progress
Center for HICS Education and Training
                                                       Situation Briefing
                                         • Briefing is conducted prior to shift change
                                            –   Situation status
                                            –   Incident objectives and priorities
                                            –   Current organization
                                            –   Resource assignments
                                            –   Resources ordered and en route
                                            –   Incident facilities
                                            –   Incident communications plan
                                            –   Incident prognosis, concern and other issues
                                            –   Introduction of Command and General Staff members
                                         • Briefing info captured on ICS Form 201/HICS 201:
                                           Incident Briefing Form** (The Initial Incident Action Plan**)
Center for HICS Education and Training
                                             The Management Meeting
                                         • Following a situation briefing and shift
                                           change is the management meeting
                                           – Attended by the agency Executive, Command Staff and
                                             General Staff
                                         • Purpose of the meeting:
                                           – Discuss overall policies, priorities and control objectives
                                           – Keeps agency leadership involved with the incident
                                             management process
                                         • Outcome:
                                           – Revised priorities, objectives and policies
                                           – Use ICS Form 202/HICS 202: Incident Objectives
Center for HICS Education and Training
                                                   The Planning Meeting
                                             These are the Incident Action Planning Meetings
                                         • Attendees:
                                           – IC, Command Staff and General Staff
                                         • Purpose:
                                              o Tactics segment:
                                                  – Discuss strategies and tactics to accomplish the revised priorities from
                                                    the Management Meeting
                                              o Identification of resources segment:
                                                  – Kind and type of resources needed to accomplish the objectives
                                                  – How resources should be organized

                                         • Outcome:
                                           – Develop the IAP
                                           – Forms: ICS Form 215: Operational Tactics Worksheet and
                                             ICS Form 215A/HICS 261: Safety Analysis
Center for HICS Education and Training
                                              The Operations Briefing
                                         • The IAP is presented for the upcoming period
                                         • Attendees:
                                           – Presented by Command/Section staff to supervisory
                                             staff**
                                         • Purpose:
                                           – To outline and communicate the objectives, strategies
                                             and resources for the upcoming operational period
                                         • Outcome:
                                           – An informed Section
                                           – Forms
                                              o ICS/HICS Form 203: Organization Assignment List and ICS Form
                                              o ICS/HICS Form 204: Division/Group Assignment List
                                             Operations Briefing Roles
Center for HICS Education and Training


                                         • Planning Section Chief
                                           – Prepares/Reviews the briefing agenda
                                           – Facilitates the briefing**
                                         • Incident Commander
                                           – Presents/confirms incident objectives
                                         • Current Operations Section Chief
                                           – Provides current assessment and accomplishments
                                         • On-coming Operations Section Chief
                                           – Presents work assignments and staffing for the
                                             next operational period
Center for HICS Education and Training       Operations Briefing Roles
                                         • Safety Officer
                                           – Reviews specific risks to operational resources and the
                                             safety measures
                                         • Specific Section Chief/Unit Leaders
                                           – Present information related to their Section
                                           – Focus on safe and efficient operations
                                         • Incident Commander
                                           – Directs resources to deploy
                                         • Planning Section Chief
                                           – Announces the time of the next Operations Briefing
                                           – Adjourns the meeting
                                                Post-Incident Actions
Center for HICS Education and Training



                                         • Assessment of incident response and
                                           recovery is critical
                                           – It is an important leadership responsibility
                                         • Assessment methods include:
                                           – Debriefing
                                           – Post-incident critique
                                           – After-action review meeting
                                           – After action report
                                           – Corrective action plan
                                                     Section Summary
Center for HICS Education and Training


                                         • ICS is used to manage expanding incidents
                                         • Within ICS, there are defined organizational
                                           positions with specific functions and titles
                                         • ICS establishes a chain of command and formal
                                           communication relationships
                                         • Common leadership and management
                                           responsibilities apply to the ICS structure
                                         • Effective management includes:
                                           – A manageable span of control
                                           – Organized and logical implementation of the ICS structure
                                           – Utilization of management activities and processes
Center for HICS Education and Training

                               Questions?
Center for HICS Education and Training


                       National Incident
                      Management System
Center for HICS Education and Training            National Incident
                                                 Management System
                                         • September 11, 2001 demonstrated the need
                                           for and importance of national standards:
                                           – Incident operations
                                           – Incident communications
                                           – Personnel qualifications
                                           – Resource management
                                           – Information management
                                           – Supporting technology
Center for HICS Education and Training               National Incident
                                                    Management System
                                         • Homeland Security Presidential Directive (HSPD) - 5
                                           Management of Domestic Incidents
                                           – Directed the Secretary of the Department of
                                             Homeland Security (DHS) to develop and administer
                                             NIMS
                                           – A nationwide “all-hazards” template for:
                                              o Federal, state, local and tribal governments
                                              o Private sector
                                              o Nongovernmental organizations
                                           – Applicable across jurisdictions and functions**
                                           – Improve coordination and cooperation in all entities
Center for HICS Education and Training                           NIMS
                                         • HSPD-5: Management of Domestic Incidents
                                           – Provides a flexible framework that applies to all
                                             phases of incident management, regardless of
                                             cause, size, location or complexity**
                                           – Requires all Federal departments and agencies to
                                             adopt NIMS
                                           – State and local organizations must adopt NIMS as
                                             a condition of Federal preparedness assistance (FY
                                             2005)
                                             o Initial adoption of ICS
                                             o Future compliance activities being developed
                                                            HSPD -8
Center for HICS Education and Training



                                         • Describes the way Federal departments and
                                           agencies will prepare
                                         • It requires DHS to develop a National
                                           Preparedness Goal in coordination with:
                                           – Other Federal departments and agencies
                                           – State, local and tribal governments
                                           – Private sector
                                             o Hospitals and healthcare systems
Center for HICS Education and Training
                                         HSPD-5: NIMS Concepts
                                         • Flexibility**
                                         • Standardization
                                           – Incident Command System
                                           – Multiagency coordination
                                           – Public information systems
                                           – Interoperable systems
                                             o Training
                                             o Resource management
                                             o Personnel qualification and certification
                                             o Equipment certification
                                             o Communications and information management
                                             o Technology support
                                             o Continuous system improvement
                                           Command and Management
Center for HICS Education and Training


                                                                                                    Command

                                         • Incident Command System
                                            – Modular and scalable                                                      Finance/
                                                                                 Operations   Planning    Logistics

                                            – Interactive management
                                                                                                                      Administration




                                              components
                                            – Common terminology, standards and
                                              procedures
                                              o Reduces confusion between incident
                                                position and their day-to-day position**
                                           – Measurable objectives and Incident
                                             Action Planning
                                          Command and Management
Center for HICS Education and Training



                                         • Incident Command System
                                            – Accountability
                                            – ICS is a proven incident management
                                              system based on organizational “best
                                              practices”**
                                            – A manageable span of control varying from
                                              3:7 reports per supervisor**
Center for HICS Education and Training
                                          Command and Management
                                         • Unified Command**
                                           – More than one responding agency with
                                             responsibility for the incident**
                                           – Incidents cross political jurisdictions
                                           – Agencies work together to:
                                             o Analyze intelligence information
                                             o Establish common objectives and strategies
                                             o Develop a common Incident Action Plan
Center for HICS Education and Training
                                           Command and Management
                                         • Area Command
                                           – Oversee management of multiple incidents
                                           – Oversee management of large incidents that cross
                                             jurisdictional boundaries

                                         • Duties
                                           – Sets overall strategy and priorities
                                           – Allocates critical resources
                                           – Ensure incident is managed, objectives are met, and
                                             strategies are followed
                                           – Area command does not have an Operations Section
                                             because Ops are conducted “on scene”**
Center for HICS Education and Training
                                          Command and Management
                                         • Multiagency Coordination Systems
                                           – Coordinating and supporting activities
                                             o Facilities
                                             o Equipment
                                             o Personnel
                                             o Procedures
                                             o Communications
                                           – Functions
                                             o Support incident management policies and priorities
                                             o Facilitate logistical support
                                             o Resource allocation decisions based on priorities**
                                             o Coordinate information
                                             o Coordinate interagency and intergovernmental issues
Center for HICS Education and Training    Command and Management
                                         • Multiagency Coordination Systems
                                           – Emergency Operations Centers (EOCs)
                                             o Supports multi-agency coordination and joint
                                               information activities**
                                             o Established by emergency management agencies
                                                – Local
                                                – State
                                             o EOC organization and staffing is flexible but
                                               includes:
                                                –   Coordination
                                                –   Communications
                                                –   Resource dispatching and tracking
                                                –   Information collection, analysis and dissemination
                           EOC Organization

                                                                Coordination
                                                                                    Other Multiagency
                                             Multiagency                              Coordination
                                          Coordination Entity                            Entities


 Resources                                                                     Resources
                                           Situation status
 Priorities                                                                    Priorities
                                           Resource needs
 Strategic coordination                                                        Strategic coordination

                           Incident                                Incident
                       Command/ Unified                        Command/ Unified
                          Command 1                               Command 2
Center for HICS Education and Training
                                          Command and Management
                                         • Multiagency Coordination Systems
                                           – Multiagency Coordination Centers (MACs)
                                             o Consist of principals from organizations
                                                – With incident management responsibilities; or
                                                – With significant incident management support or resources
                                             o Provide situation and resource status information
                                             o Establish priorities between incidents
                                             o Acquire and allocate resources
                                             o Resolve policy issues
                                             o Provide strategic coordination
                                          Command and Management
Center for HICS Education and Training


                                         • Multiagency Coordination Systems
                                           – Multiagency Coordination Centers (MACs)
                                             o Post-event responsibilities include revision of:
                                                –   Plans
                                                –   Procedures
                                                –   Communications
                                                –   Staffing
                                                –   Other capabilities for improved incident management
                                             o Revisions are based on lessons learned and are
                                               coordinated with response partners
                                           Public Information Systems
Center for HICS Education and Training


                                         • Communicating timely and accurate
                                           information to the public
                                         • Under ICS, the Public Information Officer:
                                           – Leads the public information activities
                                           – Establishes and operates within the parameters
                                             established by the Joint Information System
                                             (JIS)
                                           – Ensures that decision-makers and the public
                                             are fully informed throughout a response
                                          Public Information Systems
Center for HICS Education and Training



                                         • Joint Information Systems
                                           – The PIO operates within the parameters of the
                                             JIS to establish
                                             o Policies, procedures and protocols for gathering and
                                               disseminating information**
                                             o Includes development of a communications plan
                                           – Develop coordinated messages
                                           – Keep decision-makers and the public informed
Center for HICS Education and Training
                                          Public Information Systems
                                         • Joint Information Centers
                                           – Physical locations where information management
                                             activities are performed
                                           – Are the organizational structure for info dissemination
                                           – Can be “virtual” or staffed with PIOs from multiple
                                             agencies
                                           – Established at various levels of government
                                           – When established as part of a unified command, all
                                             agencies clear all information with the Incident
                                             Commander**
                                           – When multiple JICS are formed, they must communicate
                                             and coordinate with each other using JIS protocols**
   Integrated JICs
                 State JIC



Local JIC 1                       Local JIC 2




Agency 1                           Agency 2
  PIO                                PIO


                IC/UC/Area
                 Command
                     PIO
              (at incident JIC)
                                                 Preparedness Defined
Center for HICS Education and Training



                                         • Actions to establish and sustain prescribed
                                           levels of capability
                                           – Ensures mission integration and interoperability
                                                       Preparedness
Center for HICS Education and Training



                                         • Preparedness
                                           – Planning
                                           – Training
                                           – Exercises
                                           – Personnel qualification and certification
                                           – Equipment acquisition and certification
                                           – Mutual aid
                                           – Publications management (NIC)
Center for HICS Education and Training
                                         Responsibilities of Preparedness
                                                Organizations**
                                         • Establishing/coordinating plans and protocols
                                         • Integrating/coordinating activities
                                         • Establishing guidelines and protocols to
                                           promote interoperability
                                         • Adopting guidelines for resource
                                           management
                                         • Establishing response priorities
                                         • Establishing/maintaining multiagency
                                           coordination mechanisms
                                              Preparedness Planning
Center for HICS Education and Training



                                         • Plans describe how resources will be used
                                         • Plans describe mechanisms for:
                                           – Setting priorities
                                           – Integrating entities/functions
                                           – Establishing relationships
                                           – Ensuring that systems support all incident
                                             management activities
                                                       Types of Plans
Center for HICS Education and Training



                                         •   Emergency Operations Plans
                                         •   Procedures
                                         •   Preparedness Plans
                                         •   Corrective Action and Mitigation Plans
                                         •   Recovery Plans
                                                Training and Exercises
Center for HICS Education and Training



                                         • The NIMS Integration Center will:
                                           – Facilitate development and dissemination of
                                             national standards, guidelines, and protocols**
                                           – Facilitate use of modeling/simulation
                                           – Define general training requirements and
                                             approved courses**
                                           – Review/approve discipline-specific training
                                             requirements.
Center for HICS Education and Training
                                           Personnel Qualifications and
                                                  Certification
                                         • The NIMS Integration Center will:
                                           – Develop standards addressing:
                                              o Training
                                              o Experience
                                              o Credentialing
                                              o Currency requirements
                                              o Physical and medical fitness
                                             Equipment Certifications
Center for HICS Education and Training



                                         • The NIMS Integration Center will:
                                           – Facilitate development of national equipment
                                             standards, guidelines, and protocols

                                           – Review and approve equipment meeting national
                                             standards
Center for HICS Education and Training         Mutual Aid and EMACs
                                         •Jurisdictions at all levels are encouraged to
                                            enter into agreements with:
                                           – Other jurisdictions
                                           – Private-sector and NGOs
                                           – Private organizations
                                         •Emergency Management Assistance Compact
                                           – Agreements to supply mutual aid across state
                                             lines
                                         •Mutual aid agreements and EMACs facilitate
                                         the timely delivery of assistance during
                                         incidents**
                                             Publication Management
Center for HICS Education and Training



                                         • The development of naming and numbering
                                           conventions
                                           – Review and certification of publications
                                           – Methods for publications control
                                           – Identification of sources and suppliers for
                                             publications and related services
                                           – Management of publication distribution
                                              Resource Management
Center for HICS Education and Training



                                         • Resource management includes coordination
                                           and oversight of:
                                           – Tools
                                           – Processes
                                           – Systems
                                              Resource Management
Center for HICS Education and Training



                                         • There are four resource management tasks:
                                           – Establishing systems
                                           – Activating the systems
                                           – Dispatching resources
                                           – Deactivating resources
                                         Resource Management Concepts
Center for HICS Education and Training


                                         • Resource managers track resources
                                           continuously from mobilization through
                                           demobilization**
                                         • Standardize identification, allocation, and
                                           tracking
                                         • Classify by kind and type**
                                         • Implement credentialing system
                                         • Incorporate resources from private sector and
                                           NGOs
                                         Resource Management Principles
Center for HICS Education and Training



                                         • Advance planning
                                         • Resource identification and ordering
                                         • Resource categorization
                                         • Use of agreements
                                         • Effective management
Center for HICS Education and Training          Communications and
                                              Information Management
                                         • Communications and Information Management
                                           – Interoperability
                                           – Technology support
                                           – Technology standards
                                           – Broad-based requirements
                                           – Strategic planning and R&D (NIC)
                                         • A standard for communications and
                                           information management to ensure consistency
                                           among all who respond**
                                             Supporting Technologies
Center for HICS Education and Training



                                         • Supporting Technologies include:
                                           – Voice and data communication systems
                                           – Information management systems
                                           – Data display systems
                                           – Specialized technologies to facilitate operations
                                             and incident management
Center for HICS Education and Training
                                               Maintenance of NIMS
                                         • Ongoing Management and Maintenance
                                           – NIMS Integration Center (NIC) will**
                                             o Maintain and manage NIMS standards and national
                                               level preparedness**
                                             o Facilitate the definition of general training
                                               requirements and approved courses**
                                           – NIMSCAST: NIMS Capability Assessment Support
                                             Tool
                                           – Other tools and templates
                                           – Website:
                                             www.fema.gov/emergency/nims/nims.shtm
                                                Section Summary
Center for HICS Education and Training


                                         • HSPD #5 mandated the development
                                           of NIMS
                                         • NIMS enhances agency collaboration and
                                           coordination during a response
                                         • The NIMS components include:
                                           – Command and management
                                           – Preparedness
                                           – Resource management
                                           – Communications and information management
                                           – Supporting technologies
                                           – Ongoing management and maintenance
Center for HICS Education and Training

                               Questions?
Center for HICS Education and Training


                                               NIMS
                                          Implementation
                                            Activities for
                                           Hospitals and
                                         Healthcare Systems
                                         NIMS Implementation Activities for
Center for HICS Education and Training

                                          Hospitals and Healthcare Systems
                                         • Document September 12, 2006
                                           – Developed by NIC and DHHS
                                           – Outlines the 17 Implementation Activities for
                                             hospitals
                                           – National Bioterrorism Hospital Preparedness
                                             Program (HBHPP), administered through HRSA,
                                             outlines compliance for FY 2006 funding cycle
                                             o Training: ICS 100 and 200 and IS 700
                                         NIMS Implementation Activities for
Center for HICS Education and Training

                                          Hospitals and Healthcare Systems
                                         • Implementation document outlines:
                                           – The element
                                           – Element’s association to NIMS
                                           – Implementation Guidance
                                           – Implementation Example
                                           – References
Center for HICS Education and Training
                                         NIMS Implementation Activities for
                                          Hospitals and Healthcare Systems
                                         • NIMS Implementation Activities have seven
                                           categories:
                                           – Organizational Adoption of NIMS
                                           – Command and Management
                                           – Preparedness Planning
                                           – Preparedness Training
                                           – Preparedness Exercises
                                           – Resource Management
                                           – Communication and Information Management
Center for HICS Education and Training
                                         NIMS Implementation Elements
                                                   Organizational Adoption
                                         • Element 1– Adoption of NIMS
                                           – Adopt NIMS throughout the organization
                                           – Implementation Guidance:
                                             o Plan for full implementation
                                             o A “Phased In Approach”
                                             o Hospitals should develop a plan, strategy and timeline to
                                               implement the elements
                                                – It can be implemented over time!!! Not immediate or all at
                                                  once!
                                             o NBHPP outlines implementation elements
                                           – Example: All 17 elements are included in the
                                             hospital’s Emergency Management Program (EMP)
Center for HICS Education and Training
                                          NIMS Implementation Elements
                                                 Command and Management
                                         • Element 2 – Incident Command System
                                           – Manage all emergency incidents, exercises and
                                             preplanned events in accordance with ICS
                                           – Must include
                                             o Incident Action Planning (IAP)
                                             o Common communication plans
                                           – Adopting HICS will ensure element compliance
                                           – Example: Emergency Operations Plan (EOP)
                                             explains the use of ICS, IAP and common
                                             communication planning
Center for HICS Education and Training
                                          NIMS Implementation Elements
                                                  Command and Management
                                         • Element 3 – Multiagency Coordination System
                                           – Develop and coordinate connectivity capability with
                                             the HCC and the local ICP, 911 centers, EOCs and
                                             the State EOC and others, if applicable
                                           – Implementation Guidance:
                                             o Once local/regional MAC is established, hospitals should
                                               participate in collaborative planning
                                             o Exercises and training should be conducted
                                           – Example:
                                             o The EOP demonstrates the management and
                                               coordination between the HCC and multiagency
                                               coordination system entities
Center for HICS Education and Training   NIMS Implementation Elements
                                               Command and Management
                                         • Element 4 – Public Information System
                                           – Implements plans to communicate through a JIS
                                             or JIC
                                           – Implementation Guidance:
                                             o Hospital should identify at least one PIO,
                                               representative or spokesperson responsible for media
                                               and public info
                                             o Establish pre-event working relationships with local
                                               media, emergency management, law enforcement,
                                               public health, EMS etc.
                                           – Example:
                                             o The EOP explains the management of public info with
                                               partners
Center for HICS Education and Training     NIMS Implementation Elements
                                                      Preparedness Planning
                                         • Element 5 – NIMS Implementation Tracking
                                           – Hospitals and healthcare systems will track NIMS
                                             implementation annually as part of the EMP
                                           – Implementation Guidance:
                                             o Hospital must self certify compliance
                                             o Designate a NIMS implementation designee
                                           – Example: The hospital will track implementation
                                             activities annually with a goal of improving
                                             emergency management capability
Center for HICS Education and Training
                                         NIMS Implementation Elements
                                                     Preparedness Planning
                                         • Element 6 – Preparedness Funding
                                           – Develop and implement a system to coordinate
                                             hospital preparedness funding to employ NIMS
                                             across the organization
                                           – Implementation Guidance:
                                             o Collaborate with state and local government and hospital
                                               associations to identify and obtain preparedness funding
                                                –   State Department of Health
                                                –   State Office of Homeland Security
                                                –   State Office of Emergency Management
                                                –   Local public health
                                                –   Local emergency management
Center for HICS Education and Training
                                          NIMS Implementation Elements
                                                    Preparedness Planning

                                         • Element 6 – Preparedness Funding      (continued)

                                           – Example: The EMP includes information on local,
                                             state and federal preparedness grants received
                                             and deliverables to be achieved
Center for HICS Education and Training
                                          NIMS Implementation Elements
                                                    Preparedness Planning
                                         • Element 7 – Revise and Update Plans
                                           – Revise EOP and Standard Operating Procedures
                                             (SOPs) to incorporate NIMS
                                             o Planning
                                             o Training
                                             o Response
                                             o Exercises
                                             o Equipment
                                             o Evaluation and corrective actions
                                           – Implementation Guidance and Example:
                                             o The EMP work plan reflects status of revisions to EOPs
Center for HICS Education and Training
                                           NIMS Implementation Elements
                                                         Preparedness Planning
                                         • Element 8 – Mutual Aid Agreements/MOUs
                                           – Participate in and promote interagency mutual aid
                                             agreements (public and private sector and NGOs)
                                           – Implementation Guidance:
                                             o Establish mutual aid agreements/MOUs with:
                                                –   Neighboring hospitals/healthcare systems
                                                –   Public health departments
                                                –   HazMat Response Teams
                                                –   Local Fire and Law Enforcement
                                                –   Area pharmacies
                                                –   Medical supply vendor
                                             o Share agreements with local emergency management
                                               prior to an incident occurring
Center for HICS Education and Training
                                          NIMS Implementation Elements
                                                     Preparedness Planning
                                         • Element 8 – Mutual Aid Agreements           (Continued)

                                           – Example:
                                             o EMP documentation includes information supporting any
                                               mutual aid agreements and/or MOUs that the facility
                                               has
Center for HICS Education and Training
                                         NIMS Implementation Elements
                                                    Preparedness Training
                                         • Element 9 – IS-700: NIMS: An Introduction
                                           – Complete IS-700
                                           – Implementation Guidance:
                                             o IS-700 should be completed by hospital personnel in a
                                               leadership role in emergency preparedness, incident
                                               management, filling ICS/HICS roles and/or emergency
                                               response
                                             o Phased in training
                                             o Train others as indicated (MDs, RNs, others)
                                           – Example: The EMP training records track
                                             completion of IS-700.
Center for HICS Education and Training   NIMS Implementation Elements
                                                    Preparedness Training
                                         • Element 10 – IS-800.A: NRP
                                           – Complete IS-800
                                           – Implementation Guidance:
                                             o IS 800 should be completed by personnel whose
                                               primary responsibility is emergency management
                                             o Hospital must track training
                                           – Example:
                                             o Emergency preparedness program training records
                                               track completion of IS 800 or equivalent
                                             o Training by individual(s) responsible for the hospital’s
                                               emergency management program
Center for HICS Education and Training    NIMS Implementation Elements
                                                      Preparedness Training
                                         • Element 11 – ICS 100 HC and 200 HC
                                           – Complete ICS 100 and 200 training or equivalent
                                             courses
                                           – Implementation:
                                             o IS 100: Completed by hospital personnel that would
                                               have a direct role in emergency preparedness, incident
                                               management and/or designated to fulfill ICS roles
                                             o IS 200: Completed by personnel whose primary
                                               responsibility is emergency management
                                                – Including middle management and administration
                                                – Personnel designated to fulfill ICS roles
   Emergency Management Training Requirements for Hospital Personnel
              Training to be completed by August 31, 2007
                                          Recommended Levels of Training for Hospital
                                                       Personnel*
                                        IS 100        IS 200        IS 300       IS 400         IS 700        IS 800
                                           or            or           or            or            or             or
                                       equivalent    equivalent   equivalent    equivalent    equivalent     equivalent

              Hospital personnel
                who are likely to
                assume an ICS
                 position in the
              Hospital Command
                Center or have a
             primary responsibility
                                         X X                                                     X
                 for emergency
                  management

              Emergency Program
                   Manager               X X                                                     X             X
              Hospital Emergency
                Preparedness
                  Committee
               Members/persons
              responsible for the
                 Emergency
                                         X X                                                     X
               Management Plan

* References: 1) NIMS Integration Center, NIMS Alert: NIMS Implementation Activities for Hospitals and Healthcare Systems, September
12, 2006. 2) Health Resources and Services Administration, National Hospital Bioterrorism Preparedness Program, Fiscal Year 2005
Continuation Guidance, HRSA Announcement Number 5-U3R-05-001.
                                             NIMS Integration Center
Center for HICS Education and Training


                                         • Required training resources
                                           – Emergency Management Institute
                                              o www.training.fema.gov/EMIWeb/IS/
                                           – Self-developed/State certified courses (equivalent
                                             courses)
                                           – Center for HICS Education and Training

                                         • For questions or correspondence on NIMS
                                           – NIMS Integration Center
                                              o www.fema.gov/emergency/nims/index.shtm
Center for HICS Education and Training
                                         NIMS Implementation Elements
                                                    Preparedness Exercises

                                         • Element 12 – Training and Exercises
                                           – Incorporate NIMS/ICS into internal and external
                                             local, regional and state emergency management
                                             training and exercises
                                           – Implementation Guidance:
                                             o Include NIMS and ICS into trainings and exercises
                                             o Review plans with staff to ensure competency
                                           – Example: The EMP documentation reflects the
                                             use of NIMS/ICS
Center for HICS Education and Training    NIMS Implementation Elements
                                                        Preparedness Exercises
                                         • Element 13 – All-Hazards Exercise Program
                                           – Participate in all-hazards exercises with response partners
                                           – Implementation Guidance:
                                              o Participate in local, regional and/or state multidiscipline/agency
                                                exercises 2/year to every 2 years.
                                              o Exercise (drills, tabletops, functional or full-scale)
                                                  –   Internal and external communications
                                                  –   Receiving, triage, treatment and transfer of mass casualties
                                                  –   Progress of casualties through the system
                                                  –   Resource management
                                                  –   Security
                                                  –   Specialty lab testing
                                                  –   Site/facility safety
                                           – Example: EMP documents reflects participation
Center for HICS Education and Training    NIMS Implementation Elements
                                                       Preparedness Exercises
                                         • Element 14 – Corrective Actions
                                           – Hospitals will incorporate corrective actions into
                                             response plans and procedures
                                           – Implementation Guidance:
                                              o After exercises, develop a corrective action report
                                                 –   Actions to correct the issue/deficiency
                                                 –   Responsible person/group to implement the action
                                                 –   Due date for completion
                                                 –   Incorporate correction into P&P
                                           – Example: EMP documents a corrective action
                                             process
Center for HICS Education and Training   NIMS Implementation Elements
                                                        Resource Management
                                         • Element 15 – Response Inventory
                                           – Maintain an inventory of organizational response assets
                                           – Implementation Guidance:
                                              o Determine emergency par levels for supplies and equipment
                                              o Consider stockpiling
                                              o Develop MOUs for supply and resupply
                                           – Example: EMP documentation includes a resource
                                             inventory
                                              o   Medical/surgical supplies
                                              o   Pharmaceuticals
                                              o   PPE
                                              o   Equipment
                                              o   Staffing
                                              o   Etc.
Center for HICS Education and Training    NIMS Implementation Elements
                                                    Resource Management
                                         • Element 16 – Resource Allocation
                                           – As permissible, incorporate national standards
                                             and guidance into acquisition programs
                                           – Implementation Guidance:
                                             o As possible, establish common equipment,
                                               communications and data interoperability resources
                                               with other local response partners
                                           – Example: EMP emphasizes interoperability
Center for HICS Education and Training    NIMS Implementation Elements
                                         Communications and Information Management

                                         • Element 17 – Standard and Consistent
                                           Terminology
                                           – Apply standard and consistent terminology, in plain
                                             English standards
                                           – Implementation Guidance:
                                             o Establish common language consistent with local
                                               emergency management, public safety and public health
                                             o Use plain language (internal Emergency Codes OK)
                                           – Example: EMP emphasizes the use of plain English
                                             by staff during emergencies
Center for HICS Education and Training              Section Summary
                                         • NIMS Activities for Hospitals and
                                           Healthcare System
                                           – Include 17 elements of activities
                                           – Adopting these elements will improve a hospital’s
                                              o Preparedness
                                              o Response
                                              o Recovery
                                         • Mandated elements by August 31, 2007:
                                           – Training of selected key personnel in
                                              o ICS 100 HC and 200 HC
                                              o IS 700: NIMS
                                              o IS 800: NRP
Center for HICS Education and Training

                               Questions?
Center for HICS Education and Training

         The




       System
       Hospital
       Incident
      Command
Center for HICS Education and Training

                                             Origins of HICS

                                         How did HICS evolve and
                                           why is it important to
                                              your hospital?
                                                 From HEICS to HICS
Center for HICS Education and Training



                                         • Inception of HEICS in 1980’s with 2 revisions
                                           in 1990’s
                                         • Over 6000 hospitals across the country utilize
                                           HEICS as their response model
                                         • Obvious needs surfaced pre- and post 9/11
                                           −All hazards approach
                                           −Coordinated, community planning
                                                   HEICS IV Project
Center for HICS Education and Training



                                         • Key concept: Revision of previous models
                                         • Incident Management System for:
                                           – Daily operations
                                           – Preplanned events
                                           – Non-emergent situations
                                         • A systems approach to managing an incident
                                         • HEICS became HICS
                                           – Not just for emergencies anymore
                                                      HEICS IV Project
Center for HICS Education and Training


                                                       Intent and Objectives
                                         • Maintain the fundamental concepts
                                           -   Predictable chain of command
                                           -   Modular and scalable to the incident
                                           -   Position accountability
                                           -   Common language
                                         • Use the Incident Command System (ICS)
                                           principles and practices
                                           • ICS adapted to the unique hospital setting
                                                   HEICS IV Project
Center for HICS Education and Training


                                                    Intent and Objectives

                                         • Intended Outcomes
                                           - Incorporate current emergency management
                                             practices
                                           - Address NIMS compliance issues
                                           - Integrate CBRNE events
                                           - Maintain system scalability for all
                                           - Develop core materials
                                           - Address instructor qualifications
                                               HEICS IV Project Team
Center for HICS Education and Training


                                         • National Working Group
                                           - Hospital subject matter experts
                                         • Ex-Officio Members
                                           - AHA, JCAHO, DHS, DHHS, ASHE, NIC, EMI, HRSA
                                         • Secondary Review Group
                                           - Subject matter experts from the healthcare community
                                         • Executive Group
                                           - California EMS Authority and Contract Support Group
                                         • Contract Support Group
                                           - ER One Institute at the Washington Hospital Center
                                           - Kaiser National Healthcare Continuity Management
                                                What’s New in HICS?
Center for HICS Education and Training


                                         • All-hazards and ‘systems’ approach

                                         • A management tool

                                         • Emphasizes preparedness efforts with
                                           community partners

                                         • Scalable and adaptable for all hospitals

                                         • Assists with NIMS compliance for hospitals
                                           and healthcare systems
Center for HICS Education and Training

                                                What’s New in HICS?
                                         • Uses the Incident Command System (ICS)
                                           principles and practices
                                           −ICS adapted to the unique hospital setting
                                         • Approved by the NIMS Integration Center
                                           (NIC), HRSA and Joint Commission
                                                 New HICS Products
Center for HICS Education and Training



                                         • HICS Guidebook
                                         • Incident Management Team Chart
                                           - Replaces the HEICS Organizational Chart
                                           - Revised for consistency with NIMS
                                         • Updated Job Action Sheets
                                         • Incident Planning and Response Guides
                                         • Updated HICS Forms
                                           – Consistent with NIMS / Standard ICS
                                         • HICS Educational Materials
                                         • NIMS Implementation Activities
Center for HICS Education and Training       Why Is HICS Important to
                                                  Your Hospital?
                                         • Comply with regulatory standards and
                                           nongovernmental guidelines
                                           – The Joint Commission
                                             o Environment of Care 4.10
                                           - Health Resources and Services Administration
                                             Cooperative Agreements
                                             o NIMS compliance and Training requirements
                                           - Emergency Medical Treatment and Active Labor Act
                                           - Health Insurance Portability and Accountability Act
Center for HICS Education and Training      Why Is HICS Important to
                                                 Your Hospital?
                                         • Comply with regulatory standards and
                                           nongovernmental guidelines
                                           - OSHA
                                              o 29 CFR Part 1910 - Hazardous Materials Regulations
                                           - Centers for Medicare and Medicaid Services
                                           - National Fire Protection Association (NFPA 1600)
                                              o Standard 99 - Healthcare facilities
                                              o Standard 1600 – Disaster/Emergency Management
                                           - American Society for Testing and Materials (ATSM)
                                              o F-1288 – Guide for Planning and Response to an MCI
                                           - Superfund Amendments and Reauthorization Act
Center for HICS Education and Training
                                            Why Is HICS Important to
                                                 Your Hospital?
                                         • Assists in coordinating the hospital’s
                                           planning and response efforts and actions
                                           - Sets direction and goals in initial efforts
                                           - Assists with Incident Action Planning
                                           - Mission focused
                                         • Manages the incident using the Incident
                                          Command System
                                           – Defines roles and responsibilities
                                           – Facilitates community responder communication
                                             and mutual aid
Center for HICS Education and Training
                                            Why Is HICS Important to
                                                 Your Hospital?
                                         • Facilitates coordination with partners
                                           - Local and community (sister or “buddy”) hospitals
                                             and healthcare systems
                                           - Regional Hospital Coordination Centers
                                           - Public safety agencies
                                           - Local Emergency Management
                                           - Nongovernmental organizations (NGO)
Center for HICS Education and Training

                                           Why Is HICS Important to
                                                Your Hospital?
                                         • Serves as the foundation for your
                                           Emergency Operations Plan
                                           – HICS is NOT the EOP
                                           – HICS is a system management tool
                                                    HICS Resources
Center for HICS Education and Training



                                         • HICS Guidebook and materials
                                           – California Emergency Medical Services Authority
                                             website at:
                                             o www.emsa.ca.gov/hics/hics.asp


                                           – The Center for HICS Education and Training
                                             o www.hicscenter.org
                                                   Section Summary
Center for HICS Education and Training


                                         • HICS is useful for daily operations,
                                           preplanned events and non-emergent
                                           situations
                                         • HICS uses the Incident Command System
                                           (ICS) principles and practices
                                           −ICS adapted to the unique hospital setting
                                         − HICS complies with regulatory mandates
                                         • Assists in coordinating the hospital’s internal
                                           and external planning, response and recovery
Center for HICS Education and Training

                               Questions?
Center for HICS Education and Training



                           The
                         Hospital
                Incident Command System
Center for HICS Education and Training




                The HICS
                Guidebook
                                                The HICS Guidebook
Center for HICS Education and Training



                                         • Explains the critical components of HICS
                                         • Describes the use of HICS products and
                                           materials
                                         • Assists with emergency management
                                           planning
                                         • Guide for:
                                           – Hospital planners and responders
                                           – Community responders to understand and
                                             integrate hospitals into larger response
                                                The HICS Guidebook
Center for HICS Education and Training



                                         • The Guidebook is NOT
                                           – The definitive text on emergency preparedness
                                           – Designed to comprehensively teach the principles
                                             of incident command
                                           – Not the Emergency Management or Operations
                                             Plan
                                                 The HICS Guidebook
Center for HICS Education and Training



                                         • Chapter 1 - Introduction to HICS
                                           – History of the HEICS IV Project and transition to
                                             HICS
                                           – Scope and applicability
                                           – HEICS IV Project Team

                                         • Chapter 2 - Principles of Incident Command
                                           – History of ICS
                                           – Incident management functions
                                           – Incident action planning process
                                                 The HICS Guidebook
Center for HICS Education and Training


                                         • Chapter 3 - NIMS Compliance for Hospitals
                                           – NIMS organizational system overview
                                           – NIMS compliance activities for hospitals

                                         • Chapter 4 - Hospital Emergency
                                           Management Program
                                           – Program development
                                           – All-hazards Emergency Operations Plan
                                           – Hazard Vulnerability Analysis
                                           – Planning Partners
                                                The HICS Guidebook
Center for HICS Education and Training


                                         • Chapter 5 - Hospital Incident Command
                                           System
                                           – Incident Management Team
                                             o Command
                                             o Operations
                                             o Planning
                                             o Logistics
                                             o Finance / Administration
                                           – Incident Command Principles and Practice
Center for HICS Education and Training
                                                 The HICS Guidebook
                                         • Chapter 6 - Life Cycle of an Incident
                                           – Alert and Notification
                                           − Situation Assessment and Monitoring
                                           − Emergency Operations Plan Implementations
                                           − Establishing the Hospital Command Center
                                           − Building the ICS Structure
                                           − Incident Action Planning
                                           − Communications and Coordination
                                           − Staff Health and Safety
                                           − Operational Considerations
                                           − Legal and Ethical Considerations
                                           − Demobilization
                                           − System Restoration
                                           − Response Evaluation and Organizational Learning
                                                The HICS Guidebook
Center for HICS Education and Training


                                         • Appendices
                                           – A: Incident Planning Considerations
                                           −B: HICS Incident Management Team Chart
                                           −C: Using the Job Action Sheets
                                           −D: Using the HICS Forms
                                           −E: HEICS to HICS: Implementation Steps
                                           −F: Potential Candidates for HICS Command
                                             Positions
                                                The HICS Guidebook
Center for HICS Education and Training



                                         • Appendices
                                           −G: HEICS III to HICS Position Crosswalk
                                           −H: Working with the Scenarios, Incident Planning
                                            and Response Guides
                                           −I: NIMS Implementation Activities for Hospitals
                                               and Healthcare Systems
                                           −J: Recommended Resources
                                           −K: HEICS IV revision project organization
                                                   The HICS Guidebook
Center for HICS Education and Training



                                         • Educational materials
                                           – Module based Power Points presentations
                                             highlighting key HICS concepts
                                           – Print materials to accompany the power points
                                           – 27 scenarios to use to assist with exercise
                                             planning
                                              o 14 External scenarios
                                              o 13 Internal scenarios
                                                 The Future of HICS
Center for HICS Education and Training


                                         • HICS is a living document and system
                                           – Grows and evolves as practices and hospital
                                             needs change
                                         • Modifications made as lessons are learned
                                         • Adapted for your hospital’s unique needs
                                         • Continue to advance hospital preparedness
                                           and emergency management
                                           standardization
                                                  Section Summary
Center for HICS Education and Training



                                         • The HICS Guidebook provides
                                           – The critical components of HICS
                                           – An overview of Emergency Management
                                             principles
                                           – Guidance on how to use the HICS products and
                                             materials
Center for HICS Education and Training

                               Questions?
Center for HICS Education and Training
                                                                                                                      Incident Commander




                                                                                                       Public Information                            Safety
                                                                                                            Officer                                  Officer


                                                                                                                                                                    Biological/Infectious Disease
                                                                                                                                                                    Chemical




                                                                                                                                                                                                                                 Building the
                                                                                                                                                                    Radiological
                                                                                                            Liaison                             Medical/Technical   Clinic Administration
                                                                                                                                                                    Hospital Administration
                                                                                                            Officer                                Specialist       Legal Affairs
                                                                                                                                                                    Risk Management
                                                                                                                                                                    Medical Staff
                                                                                                                                                                    Pediatric Care
                                                                                                                                                                    Medical Ethicist




                                                                                                                                                                                                         Finance/
                                          Operations                                          Planning                                       Logistics
                                                                                                                                                                                                       Administration
                                         Section Chief                                      Section Chief                                  Section Chief
                                                                                                                                                                                                       Section Chief




                                                         Staging
                                                         Manager
                                                                        Personnel Staging Team
                                                                        Vehicle Staging Team
                                                                        Equipment/Supply
                                                                           Staging Team
                                                                        Medication Staging Team
                                                                                                            Resources
                                                                                                            Unit Leader
                                                                                                                             Personnel Tracking
                                                                                                                             Materiel Tracking
                                                                                                                                                          Service
                                                                                                                                                       Branch Director
                                                                                                                                                                                Communications Unit
                                                                                                                                                                                IT/IS Unit
                                                                                                                                                                                Staff Food & Water Unit
                                                                                                                                                                                                                     Time
                                                                                                                                                                                                                  Unit Leader
                                                                                                                                                                                                                                   Incident
                                                  Medical Care
                                                 Branch Director
                                                                   Inpatient Unit
                                                                   Outpatient Unit
                                                                   Casualty Care Unit
                                                                   Mental Health Unit
                                                                   Clinical Support Services Unit
                                                                   Patient Registration Unit
                                                                                                             Situation
                                                                                                            Unit Leader
                                                                                                                             Patient Tracking
                                                                                                                             Bed Tracking
                                                                                                                                                           Support
                                                                                                                                                       Branch Director
                                                                                                                                                                                Employee Health &
                                                                                                                                                                                  Well-Being Unit
                                                                                                                                                                                Family Care Unit
                                                                                                                                                                                Supply Unit
                                                                                                                                                                                Facilities Unit
                                                                                                                                                                                Transportation Unit
                                                                                                                                                                                Labor Pool &
                                                                                                                                                                                  Credentialing Unit
                                                                                                                                                                                                                 Procurement
                                                                                                                                                                                                                 Unit Leader
                                                                                                                                                                                                                                 Management
                                                  Infrastructure
                                                 Branch Director
                                                                   Power/Lighting Unit
                                                                   Water/Sewer Unit
                                                                   HVAC Unit
                                                                   Building/Grounds
                                                                    Damage Unit
                                                                   Medical Gases Unit
                                                                   Medical Devices Unit
                                                                   Environmental Services Unit
                                                                   Food Services Unit
                                                                                                          Documentation
                                                                                                           Unit Leader
                                                                                                                                                                                                                 Compensation/
                                                                                                                                                                                                                    Claims
                                                                                                                                                                                                                  Unit Leader
                                                                                                                                                                                                                                     Team
                                                                   Detection and Monitoring Unit
                                                                   Spill Response Unit
                                                    HazMat         Victim Decontamination Unit             Demobilization                                                                                             Cost
                                                 Branch Director   Facility/Equipment
                                                                     Decontamination Unit
                                                                                                            Unit Leader                                                                                           Unit Leader




                                                                   Access Control Unit
                                                    Security       Crowd Control Unit
                                                                   Traffic Control Unit
                                                 Branch Director   Search Unit
                                                                   Law Enforcement Interface Unit




                                                    Business       Information Technology Unit
                                                                   Service Continuity Unit
                                                   Continuity      Records Preservation Unit
                                                                   Business Function Relocation Unit
                                                 Branch Director
                                                           HICS IMT
Center for HICS Education and Training


                                         • The IMT
                                           – Depicts hospital management functions and how
                                             authority and responsibility is distributed
                                           – Each of the 5 management functions is color
                                             coded
                                             o Command (white or grey)
                                             o Operations (red)
                                             o Planning (blue)
                                             o Logistics (yellow)
                                             o Finance/Administration (green)
                                                                Incident
                                                               Commander
Center for HICS Education and Training

                                                             Command Staff
                                                                Officers


                                                              General Staff
                                            Manager

                                                                                                         HICS
                                                              Section Chief


                                                             Branch Director
                                                                                                     IMT Hierarchy
                                                               Unit Leader




                                                 Strike           Task           Single
                                                 Team             Force         Resources



                                         Note: Divisions and Groups are used in ICS but not reflected in the HICS IMT
                                                           IMT Titles
Center for HICS Education and Training



                                         • The IMT titles are distinct and standardized.
                                           This serves three important purposes: **
                                           – Allows for filling IMT positions with the most
                                             qualified persons and not by rank
                                           – Assists with requesting outside resources to staff
                                             these positions
                                           – Assists with clarifying the activities undertaken by
                                             specific personnel
                                                        IMT Hierarchy
Center for HICS Education and Training

                                         • The Incident Commander
                                           – Is the only position always activated for every
                                             incident**
                                           – Has overall responsibility to manage the incident
                                         • Command Staff
                                           – Title: Officer
                                           – Positions:
                                              o Public Information Officer
                                              o Safety Officer
                                              o Liaison Officer
                                              o Medical/Technical Specialists
                                                       IMT Hierarchy
Center for HICS Education and Training


                                         • General Staff**:
                                           – Organizational Component: Section
                                           – Title: Section Chief
                                           – Role: Responsible for major functional areas of
                                             the incident
                                           – IMT Positions:
                                              o Operations
                                              o Planning
                                              o Logistics
                                              o Finance/Administration
                                                      IMT Hierarchy
Center for HICS Education and Training


                                         • Deputy Chief Role:
                                           – The individual assuming the Deputy role will
                                             assist the Command Staff, Section Chiefs or
                                             Branch Directors** by performing delegated job
                                             activities or tasks as outlined by that JAS
                                         • Assistant Role:
                                           – A subordinate to a Command Staff or Section
                                             Chiefs who performs technical capabilities and
                                             responsibilities
                                           – They may also be assigned to a Unit Leader as
                                             situational needs dictate and resources allow
                                                         IMT Hierarchy
                                         • Branches:
Center for HICS Education and Training


                                           – Title: Branch Director
                                           – Role:
                                             o Branches can be established
                                                – Geographically or functionally**
                                                – When the number of Divisions or Groups exceed the span of
                                                  control for the Section Chief*
                                             o Branches may also be established*
                                                – In multi-disciplinary incident
                                                – In multi-jurisdictional incidents
                                                – Very large incidents
                                           – IMT Positions:
                                             o Specific to the Section’s duties
                                             o Example:
                                                – Medical Care Branch Director in Operations
                                                – Service Branch Director in Logistics
Center for HICS Education and Training
                                                        IMT Hierarchy
                                         • Divisions/Groups:
                                           – Title: Division Supervisor
                                           – Role:
                                             o Division: Divide the incident geographically
                                                – Example: first floor and second floor
                                             o Group: Divide the structure into functional areas of
                                               operation by the resources to perform the function
                                           – IMT Positions:
                                             o Divisions and Groups are not commonly used in the
                                               hospital setting
                                             o Divisions and Groups are NOT REFLECTED in the HICS
                                               IMT
Center for HICS Education and Training
                                                        IMT Hierarchy
                                         • Units:
                                           – Title: Unit Leader
                                           – Role: Functional responsibility for a specific
                                             incident activity under a Section and Branch
                                           – IMT Positions:
                                              o Specific to the Branch’s duties
                                              o Example:
                                                 – Inpatient Unit Leaders in the Medical Care Branch in the
                                                   Operations Section
                                                 – Situation Unit Leader in the Planning Section
                                                 – Labor Pool and Credentialing Unit in the Support Branch in
                                                   the Logistics Section
Center for HICS Education and Training
                                                          IMT Hierarchy
                                         • Single Resources, Strike Teams, Task Forces
                                           – Title: Leader
                                           – Role:
                                              o Single Resources:
                                                  – An individual or piece of equipment with its personnel complement
                                                    (i.e., perfusionist)
                                                  – A crew or team of individuals with a identified supervisor
                                              o Strike Teams:
                                                  – A set number of similar resources (i.e., burn RNs)
                                              o Task Forces:
                                                  – A combination of mixed resources (i.e., RNs, MDs, Techs,
                                                    Secretaries)
                                           – IMT Positions:
                                              o These are NOT REFLECTED on the HICS IMT
                                              o Can be employed by the hospital as dictated by the incident
                                              o These teams report to the Unit Leader
                                                    Building the IMT
Center for HICS Education and Training



                                         • The Incident Commander is responsible for
                                           building the Incident Command Team
                                         • The IMT is built according to the incident:
                                           – Scope and magnitude of the event
                                           – Potential/real impact to the hospital
                                           – Hospital size
                                           – Available resources
                                           – Special response needs (i.e., HazMat, biological,
                                             legal, IT)
                                                   Building the IMT
Center for HICS Education and Training



                                         • Every incident requires certain management
                                           functions be performed
                                           – The incident/problem must be evaluated
                                           – A plan must be developed to address the
                                             problems
                                           – The necessary resources must be assigned
                                           – Outcomes and effectiveness must be evaluated
                                         • Management by objectives is essential for
                                           successful Incident Action Planning**,
                                           response and recovery
                                                           Building the IMT
Center for HICS Education and Training


                                         • The IC should appoint properly trained persons
                                           to critical Command and General Staff positions
                                                                           Incident
                                                                          Commander


                                                           Public Information
                                                                 Officer        Safety Officer


                                                                                 Medical/Technical
                                                            Liaison Officer
                                                                                    Specialist




                                            Operations           Planning          Logistics         Finance/Administration
                                           Section Chief       Section Chief     Section Chief           Section Chief
                                                    Building the IMT
Center for HICS Education and Training


                                         • Once appointed:
                                           – Section Chiefs and Branch Directors staff their
                                             own sections
                                         • IMT position titles are standardized
                                           – Describe the position’s role and mission rather
                                             than the person
                                           – Allows the position to be filled by the most
                                             qualified rather than by seniority
                                           – Facilitates requests for outside qualified
                                             personnel
                                                     Building the IMT
Center for HICS Education and Training


                                         • The IMT reflects a reasonable
                                           “Span of Control”
                                           – Definition: The number of individuals or resources one
                                             supervisor can effectively manage**
                                           – Ratio of 3-7 reporting elements per 1 supervisor

                                         • The IMT structure does not exactly mirror the daily
                                           administrative structure
                                           – This is purposeful
                                           – Reduces role and title confusion during
                                             the response**
                                           − HICS IMT Crosswalk suggests position assignments
                                                                                     IMT Crosswalk
                                                                                                                                                                   Hospital Administrator/Administrator On-Call
                                                                                                                                                                   Nursing Supervisor
                                                                                                                                                                   Chief Executive Officer
                                                                                                                    Incident Commander                             Chief Operating Officer
                                                                                                                                                                   Chief Medical Officer
                                                                                                                                                                   Chief Nursing Officer
                                                                                                                                                                   Emergency Management Coordinator




       Hospital Public Information Officer               Hospital Administrator/                                                                                                      Safety Director                        Radiation Safety Officer
       Marketing Director                                 Admintrator on Call                                                                                                          Security Chief                         Employee Health
                                                                                         Public Information                                           Safety                                                                
       Patient Relations                                 Safety Director                                                                                                               Building Engineer                       Infection Control
                                                          Chief Engineer
                                                                                                Officer                                               Officer                           Emergency Management                   Risk Management
                                                                                                                                                                                         Coordinator                            Industrial Hygienist




                                                                                                                                                                                        Industrial Hygienist                   Radiation Safety Officer               Primary Care Director
   Chief Executive Officer                      Risk Management                                                                                                                       Infectious Disease                     Nuclear Medicine                       Behavior Health Director
   Emergency Management                         Chief Information Officer                                                                                                              Specialist                             Health Physicist                       Legal
                                                                                                Liaison                                      Medical/Technical
    Coordinator                                  Community Relations                                                                                                                   Infection Control                      Structural Engineer                    Risk Manager
                                                                                                Officer                                          Specialist                             Epidemiology                           Outpatient Services Administrator      Poison Control Director
                                                                                                                                                                                        Chief of Staff                         Chief of Trauma                        IT/IS Director
                                                                                                                                                                                        Chief of Pediatrics




                            Operations Section                                               Planning                                             Logistics                                                Finance/Administration
                                    Chief                                                  Section Chief                                        Section Chief                                                   Section Chief




                               Chief Operating Officer                                 Strategic Planning                                 Chief Procurement Officer                                         Chief Finance Officer
                               Chief Medical Officer                                   VP of Administration                               Support Services Director                                         VP of Finance
                               Chief Nursing Officer                                   Human Resources Director                           Supply Director                                                   VP of Business Services
                               Nursing Supervisor                                      Nursing Director                                   Chief Operating Officer                                           VP of Administration
                               Emergency Management Coordinator                        Chief Nursing Officer                              Facilities Director                                               Controller/Comptroller
                                                                                        Nursing Supervisor                                 Warehouse Director                                                Chief Information Officer
                                                                                        VP of Facilities
                                                                                        Emergency Management
                                                                                         Coordinator
                                                    Building the IMT
Center for HICS Education and Training



                                         • Positions appointed to meet the incident
                                           needs do not have to be sequential from the
                                           top down*
                                           – Appoint those positions to meet the immediate
                                             needs of the incident
                                             o Example……..
Center for HICS Education and Training
                                             Building the IMT - Example
                                               Situation: It is 4:00 am and a large fire erupts in the
                                           laboratory, located very close to two patient care areas with a
                                                                    high census.
                                                      IC activates IMT positions needed immediately!


                                           I will oversee                                                       I ensure safety
                                                                           Incident
                                            the medical                   Commander
                                                                                                               of the patients,
                                                care                                                           staff and facility

                                                                                      Safety Officer




                                          I ensure                                                                          I am needed to
                                         HVAC, Med                                                                               call in
                                         Gases and       Medical Care                                                       additional staff
                                           assess       Branch Director                                                      to assist with
                                          damage                                                                              evacuation
                                                         Infrastructure
                                                                                                        Labor Pool and
                                                        Branch Director
                                                                                                       Credentialing Unit
                                                                                                            Leader
                                               IMT Communications
Center for HICS Education and Training



                                         • Communication and information-sharing in
                                           the IMT should occur:
                                           – Up and down the chain of command
                                           – Across Sections to the appropriate
                                             Section/Branch/Unit**
                                         • Information should be displayed on status
                                           boards and easily accessed
                                         • Communications should be documented for
                                           accountability and archiving
                                                   Section Summary
Center for HICS Education and Training



                                         • Incidents may be different but the IMT
                                           fundamentals remain the same:
                                           – Positions activated and structure of IMT meet the
                                             needs of the incident
                                           – Positions are filled by qualified and trained
                                             personnel
                                             o Based on qualifications rather than by seniority
                                         • The HICS IMT has a defined hierarchy and
                                           chain of command and reporting
Center for HICS Education and Training

                               Questions?
Center for HICS Education and Training




                 Command
                                                         Command
Center for HICS Education and Training



                                         • Command functions
                                           – Maintain overall management of the incident
                                           – Set the incident objectives and priorities
                                           – Devise and approve strategies
                                           – Ensure mission completion
                                         • Incident Commander in charge
                                         • Command consists of:
                                           – Command staff
                                           – General staff
Center for HICS Education and Training

                                                        Incident Commander
                                                                                           Command


                                         Public Information                  Safety
                                              Officer                        Officer

                                                                                           Biological/Infectious
                                                                                           Disease
                                                                                           Chemical
                                                                                           Radiological
                                              Liaison                  Medical/Technical   Clinic Administration
                                                                                           Hospital Administration
                                              Officer                     Specialist       Legal Affairs
                                                                                           Risk Management
                                                                                           Medical Staff
                                                                                           Pediatric Care
                                                                                           Medical Ethicist
Center for HICS Education and Training
                                                Incident Commander
                                         • Mission:
                                           – Organize and direct the Hospital Command
                                             Center (HCC). Give overall strategic direction for
                                             hospital incident management and support
                                             activities, response and recovery. Authorize total
                                             facility evacuation if warranted

                                           – The first Incident Commander is responsible until
                                             the authority is delegated to another person**
                                                Incident Commander
Center for HICS Education and Training


                                         • Duties:
                                           – Ensure incident safety *
                                           – Initiate HICS and activation of the HCC
                                           – Determine scope and magnitude of event and
                                             potential impacts on the facility
                                           – Determine and activate appropriate IMT positions
                                           – Initiate and approve the IAP
                                           – Providing information services to internal and
                                             external stakeholders*
                                           – Liaison with Governing Board and other
                                             organizations*
Center for HICS Education and Training      Public Information Officer
                                         • Mission:
                                           – Serve as the conduit for information to internal and
                                             external stakeholders**, including staff, visitors and
                                             families, and the news media, as approved by the
                                             Incident Commander
                                         • Duties:
                                           – Determine parameters of information release from the IC
                                           – Determine any restrictions in content (sensitive materials)
                                           – Collaborate with local community officials (JIC) on risk
                                             communication messages for consistent content
                                           – Maintain contact with Situation Unit Leader for current
                                             information and facility status
                                           – Schedule regular media briefings and press releases
                                         • Report to: Incident Commander
Center for HICS Education and Training                 Safety Officer
                                         • Mission:
                                           – Ensure safety of staff, patients, and visitors,
                                             monitor and correct hazardous conditions. Have
                                             authority to halt any operation that poses
                                             immediate threat to life and health
                                         • Duties:
                                           – Determine safety risks of the incident to
                                             personnel, the hospital facility, and the
                                             environment
                                           – Initiate corrective/protective actions for safety
                                             issues
                                         • Report to: Incident Commander
Center for HICS Education and Training
                                                        Liaison Officer
                                         • Mission:
                                           – Function as the incident contact person in the Hospital
                                             Command Center for representatives from other agencies
                                         • Duties:
                                           – Is the primary contact for supporting agencies and
                                             organizations assisting at an incident but not participating
                                             in the HCC/ICS structure**
                                           – Establish contacts with liaison counterparts in each
                                             assisting and cooperating agency (including other
                                             hospitals, RHCCs, EOCs and others)
                                           – Update governmental liaisons on the hospital status and
                                             response
                                           – Make facility needs and requests for assistance and
                                             resources
                                         • Reports to: Incident Commander
                                         Medical/Technical Specialists
Center for HICS Education and Training



                                         • The Specialist Position is new and unique to
                                           HICS
                                           – A category of personnel w/specialized expertise
                                           – Activated based on situational need
                                           – Primarily are consultants but can have delegated
                                             authority
                                           – Can have more than one in activated at a time
                                           – May report to any position in the IMT
                                         • Hospitals can create other categories as
                                           needed
                                         Medical/Technical Specialists
Center for HICS Education and Training


                                         • Specialist Roles
                                           –   Biological/Infectious disease
                                           –   Chemical
                                           –   Radiological
                                           –   Clinic Administration
                                           –   Hospital Administration
                                           –   Legal affairs
                                           –   Risk management
                                           –   Medical Staff
                                           –   Pediatric Care
                                           –   Medical Ethicist
                                           –   ** Others can be developed as needed by the
                                               hospital
                                         Medical/Technical Specialists
Center for HICS Education and Training


                                         • Mission:
                                           – Advise the Incident Commander and/or assigned
                                             Section on issues related to emergency response
                                             in their area of expertise
                                         • Duties:
                                           – May be assigned as technical advisor in the HCC
                                           – May be assigned to advise and oversee specific
                                             hospital operations
                                              o Example: Decontamination operations during a
                                                chemical exposure situation
Center for HICS Education and Training
                                                   Section Summary
                                         • The Incident Commander is the only position
                                           that will ALWAYS be activated
                                         • The Incident Commander has
                                           overall responsibility for:
                                           – Management of the Incident
                                           – Activities within the HCC
                                           – Continuing as IC until authority is delegated to
                                             another
                                         • The Command Staff consists of:
                                           – PIO              − Safety Officer
                                           – Liaison          − Medical/Technical Specialists
Center for HICS Education and Training

                               Questions?
                                             Let’s talk about Sections
Center for HICS Education and Training




                                                                             Incident Commander




                                                              Public Information                  Safety
                                                                   Officer                        Officer


                                                                                                                Biological/Infectious Disease
                                                                                                                Chemical
                                                                                                                Radiological
                                                                   Liaison                  Medical/Technical   Clinic Administration
                                                                                                                Hospital Administration
                                                                   Officer                     Specialist       Legal Affairs
                                                                                                                Risk Management
                                                                                                                Medical Staff
                                                                                                                Pediatric Care
                                                                                                                Medical Ethicist




                                                                                                                                                  Finance/
                                          Operations       Planning                           Logistics
                                                                                                                                                Administration
                                         Section Chief   Section Chief                      Section Chief
                                                                                                                                                Section Chief
                                                           Sections
Center for HICS Education and Training



                                         • Sections are:
                                           – Operations
                                           – Planning
                                           – Logistics
                                           – Finance/Administration
                                         • Sections are led by a Chief
                                         • Section Chiefs are known as General Staff **
                                                                                                  Operations
Center for HICS Education and Training
                                                                                                 Section Chief



                                                                                                                                     Staging Manager




                                                                                                                 Personnel Staging                  Vehicle Staging Team
                                                                                                                   Team Leader                             Leader




                                                                                                                                                                                                         The
                                                                                                                Equipment/Supply                       Medication Staging
                                                                                                               Staging Team Leader                       Team Leader




                                          Medical Care                Infrastructure             HazMat Branch                       Security Branch                  Business Continuity
                                         Branch Director             Branch Director                Director                            Director                       Branch Director




                                             Inpatient Unit Leader
                                                                          Power/Lighting Unit
                                                                               Leader
                                                                                                       Detection and
                                                                                                    Monitoring Unit Leader
                                                                                                                                         Access Control Unit
                                                                                                                                              Leader
                                                                                                                                                                            Information Technology
                                                                                                                                                                                  Unit Leader
                                                                                                                                                                                                      Operations
                                                                                                                                                                                                       Section
                                                                          Water/Sewer Unit           Spill Response Unit                  Crowd Control Unit                Service Continuity Unit
                                            Outpatient Unit Leader
                                                                              Leader                        Leader                             Leader                               Leader




                                              Casualty Care Unit                                   Victim Decontamination                 Traffic Control Unit              Records Preservation
                                                                          HVAC Unit Leader
                                                   Leader                                                Unit Leader                             Leader                         Unit Leader




                                                                                                     Facility/Equipment
                                              Mental Health Unit          Building/Grounds                                                                                   Business Function
                                                                                                    Decontamination Unit                  Search Unit Leader
                                                   Leader                Damage Unit Leader                                                                                 Relocation Unit Leader
                                                                                                            Leader




                                               Clinical Support           Medical Gases Unit                                               Law Enforcement
                                             Services Unit Leader              Leader                                                    Interface Unit Leader




                                             Patient Registration        Medical Devices Unit
                                                 Unit Leader                   Leader




                                                                        Environmental Services
                                                                              Unit Leader




                                                                          Food Services Unit
                                                                               Leader
Center for HICS Education and Training
                                                Operations Section
                                         • Section Mission:
                                           – Manage tactical operations**
                                           – Direct all tactical resources
                                           – Carry out the mission and Incident Action Plan
                                         • Lead by a Section Chief
                                         • Largest section of resources to marshal and
                                           coordinate
                                           – Tactical resources are classified**:
                                              o Assigned
                                              o Available
                                              o Out-of-Service
                                                  Operations Section
Center for HICS Education and Training



                                         • The Section includes:
                                           – Staging Area
                                           – Medical Care Branch
                                           – Infrastructure Branch
                                           – HazMat Branch
                                           – Security Branch
                                           – Business Continuity Branch
                                               Operations Section Chief
Center for HICS Education and Training


                                         • Mission:
                                           – Develop and implement strategy and tactics to carry out
                                             the objectives established by the Incident Commander.
                                             Organize, assign, and supervise Staging, Medical Care,
                                             Infrastructure, Security, Hazardous Materials, and
                                             Business Continuity Branch resources
                                         • Duties:
                                           –   Appoint Section personnel as indicated by event
                                           –   Conduct Section briefings, update Unit Leaders
                                           –   Maintain current status of all areas in the Section
                                           –   Communicate with and advise the IC on Section
                                               issues/needs
                                             Operations Section Chief
Center for HICS Education and Training



                                         • Supervises:
                                           – Staging Manager
                                           – Medical Care Branch Director
                                           – Infrastructure Branch Director
                                           – HazMat Branch Director
                                           – Security Branch Director
                                           – Business Continuity Branch Director
                                                      Staging Manager
Center for HICS Education and Training



                                         • Mission:
                                           – Organize and manage the deployment of
                                             supplementary resources, including personnel,
                                             vehicles, equipment, supplies, and medications
                                         • Supervises:
                                           – Personnel Staging Team
                                           – Vehicle Staging Team
                                           – Equipment/Supply Staging Team
                                           – Medication Staging Team
                                                     Staging Manager
Center for HICS Education and Training


                                         • Duties:
                                           – Coordinate delivery of needed resources to
                                             requesting area
                                              o Once resources are acquired by Logistics, they are
                                                then staged with the Staging Manager
                                           – Establish a staging area in a central location
                                              o Area must be large enough to “stage” resources
                                           – Works closely with the Logistics Section
                                           – If staging area resources become too great,
                                             appoint appropriate Team Leaders
                                         Medical Care Branch Director
Center for HICS Education and Training

                                         • Mission:
                                           – Organize and manage the delivery of emergency,
                                             inpatient, outpatient, and casualty care, and
                                             clinical support services
                                         • Duties:
                                           – Addresses provision of acute AND continuous
                                             care
                                           – Works closely with Logistics Section to ensure
                                             resource acquisition
                                           – Works closely with Staging Manager for delivery
                                             of resources to areas
                                          Medical Care Branch Director
Center for HICS Education and Training



                                         • Supervises:
                                           – Inpatient Unit Leader (all inpatient units)
                                           – Outpatient Unit Leader (all outpatient services)
                                           – Casualty Care Unit Leader (Emergency Dept.)
                                           – Mental Health Unit Leader
                                           – Clinical Support Unit Leader (Lab, Diagnostic
                                             Imaging, Pharmacy, Morgue, Blood Donor)
                                           – Patient Registration Unit Leader
                                         • Reports to the Operations Section Chief
                                         Infrastructure Branch Director
Center for HICS Education and Training



                                         • Mission:
                                           – Organize and manage the services required to sustain and
                                             repair the hospital’s infrastructure operations
                                         • Duties:
                                           – Maintains overall facility operations and normal operating
                                             capacity
                                           – Identify and fix utility service-delivery failures
                                              o Coordinate the acquisition of parts or contractors with the
                                                Logistics Section
                                           – Assign a strike team to address damage to the facility as
                                             needed
                                         Infrastructure Branch Director
Center for HICS Education and Training


                                         • Supervises:
                                           – Power/Lighting Unit Leader
                                           – Water/Sewer Unit Leader
                                           – HVAC Unit Leader
                                           – Building/Grounds Unit Leader
                                           – Medical Gases Unit Leader
                                           – Medical Devices Unit Leader
                                           – Environmental Services Unit Leader
                                           – Food Services Unit Leader (for inpatients)
                                         • Reports to Operations Section Chief
                                              HazMat Branch Director
Center for HICS Education and Training


                                         • Mission:
                                           – Organize and direct hazardous material incident response
                                             activities: detection and monitoring; spill response; victim,
                                             technical, and emergency decontamination; and facility
                                             and equipment decontamination
                                         • Duties:
                                           – Oversee the operations involving a hazmat event
                                              o Decontamination of victims, staff, facility
                                              o Safe and appropriate use of PPE
                                              o Clean up operations
                                           – Collaborates closely with Medical Care Branch Director
                                              HazMat Branch Director
Center for HICS Education and Training



                                         • Supervises:
                                           – Detection and Monitoring Unit Leader
                                           – Spill Response Team Unit Leader
                                           – Victim Decontamination Unit Leader
                                           – Facility/Equipment Decontamination Unit Leader
                                         • Reports to Operations Section Chief
                                             Security Branch Director
Center for HICS Education and Training


                                         • Mission:
                                           – Coordinate all of the activities related to internal
                                             and external personnel and facility security
                                         • Duties:
                                           – Implement facility security measures
                                           – Ensure security and access control of the HCC
                                           – Liaison with responding law enforcement
                                             personnel
                                           – Oversee search and rescue operations for the
                                             facility
                                             Security Branch Director
Center for HICS Education and Training



                                         • Supervises
                                           – Access Control Unit Leader
                                           – Crowd Control Unit Leader
                                           – Traffic Control Unit Leader
                                           – Search Unit Leader
                                           – Law Enforcement Interface Unit Leader
                                         • Reports to the Operations Section Chief
Center for HICS Education and Training
                                         Business Continuity Branch Director
                                         • Mission:
                                           – Ensure business functions are maintained, restored or
                                             augmented to meet designated Recovery Time Objectives
                                             (RTO) and provide limited interruptions to continuity of
                                             essential business operations
                                           – Can be activated immediately or as needed during the
                                             response
                                         • Duties:
                                           – Facilitate the acquisition of and access to essential
                                             recovery resources, including business records
                                           – Support Branches with relocation to alternate business
                                             sites
                                           – Coordinate IT services with Logistics Section
                                           – Assist Branches and impacted areas to restore normal
                                             operations
Center for HICS Education and Training
                                                  Business Continuity
                                                   Branch Director
                                         • Supervises:
                                           – Information Technology Unit Leader
                                             o Mission: Ensure IT business functions are maintained,
                                               restored or augmented
                                             o Works closely with Logistics Section IT/IS Unit
                                           – Service Continuity Unit Leader
                                             o Mission: Ensure business/clinical/ancillary service
                                               functions are maintained, restored or augmented
Center for HICS Education and Training
                                                 Business Continuity
                                                  Branch Director
                                         • Supervises:
                                           – Records Preservation Unit Leader
                                             o Mission: Ensure vital business/medical records are
                                               maintained and preserved
                                           – Business Function Relocation Unit Leader
                                             o Mission: Ensure business functions are moved to
                                               alternative work sites
                                                   Section Summary
Center for HICS Education and Training




                                         • The Operations Section is responsible for
                                           – All tactical operations,**
                                           – The tactical objectives and organization
                                           – Directing all tactical resources
                                         • Operations Section is led by a Chief
                                         • Operations Section positions are activated as
                                           needed by the incident
Center for HICS Education and Training

                               Questions?
Center for HICS Education and Training
                                                                               Logistics Section
                                                                                     Chief




                                                     Service Branch
                                                        Director
                                                                                                             Support Branch
                                                                                                                Director
                                                                                                                                                The
                                                                                                                                             Logistics
                                         Communications
                                           Unit Leader
                                                                 IT/IS Unit Leader
                                                                                            Employee Health
                                                                                            & Well-Being Unit
                                                                                                Leader
                                                                                                                        Family Care Unit
                                                                                                                            Leader
                                                                                                                                              Section
                                                      Staff Food &
                                                                                               Supply Unit                Facilities Unit
                                                       Water Unit
                                                                                                 Leader                     Leader
                                                        Leader



                                                                                                                          Labor Pool &
                                                                                             Transportation
                                                                                                                        Credentialing Unit
                                                                                              Unit Leader
                                                                                                                            Leader
                                                            Logistics
Center for HICS Education and Training


                                         • Provides support to other sections
                                         • Acquires resources from internal and external
                                           sources
                                           – Activate existing MOUs, contracts and vendor
                                             agreements
                                           – Employs standard and emergency procurement and
                                             contracting procedures
                                         • With Liaison, links to local EOC and/or Regional
                                           Hospital Coordination Center for resource
                                           requests
                                             Logistics and Operations
Center for HICS Education and Training



                                         • Logistics and Operations are closely linked
                                           and must work collaboratively together
                                           – Logistics Section is the “getters”
                                           – Operations Section is the “doers”
                                         • Scope and Responsibilities overlap
                                           – Logistics Supply Unit and Operations’
                                             Infrastructure Branch
                                           – Labor Pool and Credentialing Unit and Staging
                                             Manager– Personnel Team Leader
Center for HICS Education and Training
                                               Logistics Section Chief
                                         • Mission:
                                           – Organize and direct those operations associated
                                             with maintenance of the physical environment
                                             and with the provision of human resources,
                                             materiel, and services to support the incident
                                             activities. Participate in Incident Action Planning
                                         • Duties:
                                           – Oversee the acquisition of resources
                                           – Maintain current status of all areas in the section
                                               Logistics Section Chief
Center for HICS Education and Training



                                         • Supervises:
                                           – Service Branch Director
                                           – Support Branch Director


                                         • Reports to the Incident Commander
                                             Service Branch Director
Center for HICS Education and Training


                                         • Mission:
                                           – Organize and manage the services required to
                                             maintain the hospital’s communication system,
                                             food and water supply for staff, and information
                                             technology and systems
                                         • Oversees:
                                              o Communications Unit Leader
                                              o IT/IS Unit Leader
                                              o Staff Food and Water Unit Leader
Center for HICS Education and Training
                                          Service Branch Unit Leaders
                                         • Communications Unit Leader
                                           – Mission: Organize and coordinate internal and external
                                             communications connectivity
                                         • IT/IS Unit Leader
                                           – Mission: Provide computer hardware, software and
                                             infrastructure support to staff
                                           – Coordinates closely with Operations Section Business
                                             Continuity Branch, IT Unit
                                         • Staff Food and Water Unit Leader
                                           – Mission: Organize food and water stores and prepare for
                                             rationing during periods of anticipated or actual
                                             shortage
                                           – Coordinates closely with Operations Section
                                             Infrastructure Branch, Food Services Unit
Center for HICS Education and Training         Support Branch Director
                                         • Mission:
                                           – Organize and manage the services required to maintain
                                             the hospital’s supplies, facilities, transportation, and
                                             labor pool. Ensure the provision of logistical,
                                             psychological, and medical support of hospital staff and
                                             their dependents.
                                         • Oversees:
                                           –   Employee Health and Well-Being Unit Leader
                                           –   Family Care Unit Leader
                                           –   Supply Unit Leader
                                           –   Facilities Unit Leader
                                           –   Transportation Unit Leader
                                           –   Labor Pool and Credentialing Unit Leader
Center for HICS Education and Training    Support Branch Unit Leaders
                                         • Employee Health and Well Being Unit
                                          (Known as the “Medical Unit” in ICS**)
                                           – Mission:
                                              o Provide medical screening, evaluation and follow-up of employees
                                                who are assigned to the incident**
                                              o Ensure the availability of medical care for injured or ill staff
                                              o Ensure the availability of behavioral and psychological support
                                                services to meet staff needs during and following an incident.
                                              o Coordinate mass prophylaxis/vaccination/immunization of staff, if
                                                required. Coordinate medical surveillance program for employees

                                         • Family Care Unit
                                           – Mission:
                                              o Ensure the availability of medical, logistic and mental health and
                                                day care for the families of staff members. Coordinate mass
                                                prophylaxis/vaccination/immunization of family members if
                                                required
Center for HICS Education and Training
                                         Support Branch Unit Leaders
                                         • Supply Unit
                                           – Mission:
                                             o Acquire, inventory, maintain, and provide medical
                                               and non-medical care equipment, supplies, and
                                               pharmaceuticals

                                         • Facility Unit
                                           – Mission:
                                             o Organize, manage and support building systems,
                                               equipment and supplies. Ensure proper cleaning and
                                               disinfection of hospital environment.
Center for HICS Education and Training    Support Branch Unit Leaders
                                         • Transportation Unit
                                           – Mission:
                                             o Organize and coordinate the transportation of all
                                               ambulatory and non-ambulatory patients. Arrange for
                                               the transportation of human and materiel resources
                                               within or outside the facility

                                         • Labor Pool and Credentialing Unit
                                           – Mission:
                                             o Collect and inventory available staff and volunteers at
                                               a central point (Labor Pool) for assignment by the
                                               Staging Officer. Maintain adequate numbers of both
                                               medical and non-medical personnel. Assist in the
                                               maintenance of staff morale
                                             o Coordinates closely with Operations Section Staging
                                               Manager
                                                   Section Summary
Center for HICS Education and Training



                                         • The Logistics Section supports the
                                           resource requirements of the response
                                         • Logistics Section has two branches:
                                           – Support
                                           – Service
                                         • The Logistics Section is led by a Chief**
                                         • Logistics works closely with the Operations
                                           Section
Center for HICS Education and Training

                               Questions?
Center for HICS Education and Training
                                                                            Planning Section
                                                                                 Chief




                                         Resources Unit         Situation Unit           Documentation    Demobilization
                                            Leader                 Leader                 Unit Leader      Unit Leader




                                               Personnel

                                                                                                         Planning
                                                                   Patient Tracking
                                                Tracking
                                                                       Manager
                                               Manager



                                            Materiel Tracking        Bed Tracking
                                                                                                         Section
                                               Manager                 Manager
Center for HICS Education and Training
                                                  Planning Section
                                         • Section Mission:
                                           – Collect, evaluate, and disseminate incident
                                             action information and intelligence to Incident
                                             Commander*
                                           – Prepare status report and display various
                                             information
                                           – Develop the Incident Action Plan (IAP)

                                         • Lead by a Section Chief
Center for HICS Education and Training
                                               Planning Section Chief
                                         • Mission:
                                           – Oversee all incident-related data gathering and
                                             analysis regarding incident operations and
                                             assigned resources, develop alternatives for
                                             tactical operations, conduct planning meetings,
                                             and prepare the Incident Action Plan (IAP) for
                                             each operational period
                                         • Duties:
                                           – Ensure distribution of critical information/data
                                           – Compile scenario projections from all Section
                                             Chiefs and effect long range planning
                                           – Document and distribute the facility action plan
                                           – Conduct Section briefings, update Unit Leaders
                                           – Maintain current status of all Sections
                                               Planning Section Chief
Center for HICS Education and Training



                                         • Supervises:
                                           – Resources Unit Leader
                                           – Situation Unit Leader
                                           – Documentation Unit Leader
                                           – Demobilization Unit Leader
                                               Resource Unit Leader
Center for HICS Education and Training


                                         • Mission:
                                           – Maintain information on the status, location, and
                                             availability of personnel, teams, facilities,
                                             supplies, and major equipment to ensure
                                             availability of use during the incident. Maintain
                                             a master list of all resources assigned to
                                             incident operations
                                         • Oversees:
                                           – Personnel Tracking Leader
                                           – Materiel Tracking Leader
                                                    Tracking Leaders
Center for HICS Education and Training



                                         • Personnel Tracking Leader
                                           – Mission:
                                             o Maintain information on the status, location, and
                                               availability of on-duty staff and volunteer personnel
                                         • Materiel Tracking Leader
                                           – Mission:
                                             o Maintain information on the status, location, and
                                               availability of equipment and supplies within the
                                               hospital inventory and additional materiel received
                                               from outside agencies in support of the incident
Center for HICS Education and Training
                                                 Situation Unit Leader
                                         • Mission:
                                           – Collect, process, and organize ongoing situation
                                             information; prepare situation summaries; and develop
                                             projections and forecasts of future events related to the
                                             incident. Prepare maps and gather and disseminate
                                             information and intelligence for use in the Incident
                                             Action Plan (IAP)
                                         • Focus is on current and future situation
                                           management
                                         • Writes and maintains situation updates and IAPs
                                         • Maintains the HCC Status Boards
                                                Situation Unit Leader
Center for HICS Education and Training



                                         • The Situation Unit is very busy!
                                           – Staff with lots of clerical assistance
                                           – Staff with people to monitor TV, media
                                           – Networks closely with the Liaison Officer

                                         • Supervises:
                                            – Patient Tracking Leader
                                            – Bed Tracking Leader
                                                     Tracking Leaders
Center for HICS Education and Training


                                         • Patient Tracking Leader:
                                           – Mission:
                                              o Monitor and document the location of patients at all
                                                times within the hospital's patient care system, and
                                                track the destination of all patients departing the
                                                facility
                                         • Bed Tracking Leader:
                                           – Mission:
                                              o Maintain information on the status, location, and
                                                availability of all patient beds, including disaster cots
                                                and stretchers
Center for HICS Education and Training            Documentation Unit
                                         • Mission:
                                           – Maintain accurate and complete incident files,
                                             including a record of the hospital’s/HCC response
                                             and recovery actions and decisions; provide
                                             duplication services to incident personnel; and file,
                                             maintain, and store incident files for legal, analytical,
                                             and historical purposes
                                         • Duties:
                                           – Collects, organizes and archives all response and
                                             recovery documentation and paperwork (forms)
                                           – Assists in writing the Incident Action Plan (IAP)
                                           – Assists in preparing the After-Action Report and
                                             Corrective/Improvement Plan based on lessons
                                             learned**
                                           – Works closely with the Situation Unit Leader
                                                Demobilization Unit
Center for HICS Education and Training


                                         • Mission:
                                           – Develop and coordinate an Incident
                                             Demobilization Plan that includes specific
                                             instructions for all staff and resources that will
                                             require demobilization

                                         • Duties:
                                           – Responsible for drafting demobilization and
                                             system/business recovery plan for the incident approved
                                             by the Command Staff/Incident Commander
                                           – Demobilization starts EARLY in the response!
                                                   Section Summary
Center for HICS Education and Training


                                         • The Planning Section is responsible for:
                                           – Collecting, evaluating and disseminating incident
                                             situation information and intelligence to the HCC
                                           – Maintaining resource status
                                           – Developing the Incident Action Plan (IAP) **
                                           – Archiving all response and recovery
                                             documentation
                                           – Assisting with development of the After-Action
                                             Report
                                         • The Planning Section is led by a Chief
Center for HICS Education and Training

                               Questions?
Center for HICS Education and Training
                                          Finance/Administration
                                                 Section
                                                                            Finance/
                                                                          Administration
                                                                          Section Chief




                                                                                      Compensation/
                                                            Procurement Unit
                                         Time Unit Leader                              Claims Unit    Cost Unit Leader
                                                                Leader
                                                                                         Leader
                                         Finance/Administration Section
Center for HICS Education and Training



                                         • Section Mission:
                                           – Account for costs incurred from the outset of
                                             the response
                                           – Account for expenses from multiple cost centers
                                           – Monitor, track and report personnel, time,
                                             repair, purchase, and replacement expenses
                                             and lost revenue
                                           – Modify or expand daily (usual) accounting
                                             practices to meet the needs of the incident and
                                             outlined in the EOP
                                         • Section led by a Chief
Center for HICS Education and Training        Finance/Administration
                                                   Section Chief
                                         • Mission:
                                           – Monitor the utilization of financial assets and the
                                             accounting for financial expenditures. Supervise
                                             the documentation of expenditures and cost
                                             reimbursement activities

                                         • Duties:
                                           – Oversee the acquisition of supplies and services
                                             to carry out the medical mission
                                           – Supervise the documentation of expenditures
                                             relevant to the emergency incident
                                           – Directs financial RECOVERY
                                              Finance/Administration
Center for HICS Education and Training


                                                   Section Chief
                                         • Supervises:
                                           – Time Unit Leader
                                           – Procurement Unit Leader
                                           – Compensation/Claims Unit Leader
                                           – Cost Unit Leader
                                                      Time Unit Leader
Center for HICS Education and Training



                                         • Mission:
                                           – Responsible for the documentation of personnel
                                             time records. Monitor and report on regular and
                                             overtime hours worked/volunteered
                                         • Adjusts reports and tracking to meet the
                                           needs of the incident
                                           – Tracking of altered or expanded work
                                             periods/shifts
                                           – Developing specialized tracking forms to capture
                                             response and recovery time
                                            Procurement Unit Leader
Center for HICS Education and Training



                                         • Mission:
                                           – Responsible for administering accounts receivable
                                             and payable to contract and non-contract
                                             vendors
                                         • Initiates emergency contracts
                                              o Agreements should be already in place
                                              o Confirm existing vendors can deliver in emergencies
                                              o Confirm payment arrangements
                                         • Manages purchase orders
Center for HICS Education and Training         Compensation/Claims
                                                   Unit Leader
                                         • Mission:
                                           – Responsible for receiving, investigating and
                                             documenting all claims reported to the hospital
                                             during the emergency incident, which are alleged to
                                             be the result of an accident or action on hospital
                                             property
                                         • Duties:
                                           – Manages claims and worker’s compensation issues
                                              o Injury/illness to staff, volunteers and visitors
                                              o Should have comprehensive line of duty death procedure to
                                                implement if needed
                                              o Follow up coverage/compensation/benefits clearly outlined
                                                and shared with staff member
Center for HICS Education and Training
                                                       Cost Unit Leader
                                         • Mission:
                                           – Responsible for providing cost analysis data for the
                                             declared emergency incident and maintenance of
                                             accurate records of incident cost
                                         • Duties:
                                           – Track and pay response and recovery costs
                                           – Projects lost revenue
                                           – Prepares documents for state/federal reimbursement
                                             when applicable
                                           – Tracks payments
                                              o Patient insurance and reimbursement
                                              o Government
                                                    Section Summary
Center for HICS Education and Training


                                         • The Finance/Administration Section**
                                           – Manages costs related to the incident
                                           – Provides
                                              o Accounting
                                              o Procurement
                                              o Time recording
                                              o Cost analysis
                                         • The Section is led by a Chief**
Center for HICS Education and Training

                               Questions?
Center for HICS Education and Training




                  Job Action Sheets
                                                  Purpose of the JAS
Center for HICS Education and Training



                                         • An incident management tool to familiarize
                                           the user with critical aspects of the command
                                           position he or she is assuming.

                                         • The series of action steps are intended to
                                           “prompt” the incident management team
                                           members to take needed actions related to
                                           their roles and responsibilities
                                                      Use of the JAS
Center for HICS Education and Training


                                         • HICS provides 78 Job Action Sheets
                                         • In most cases only a portion of these
                                           positions will be necessary for a successful
                                           response
                                         • Activation of HICS positions may be based
                                           on:
                                           – Scope and magnitude of the event
                                           – Hospital size
                                           – Available resources
                                           – Response needs
                                                            JAS Format
Center for HICS Education and Training



                                         • The key format considerations for each JAS are the
                                           same and include the following information:
                                           – Command Title – the name of the position
                                           – Mission – a brief statement summarizing the basic
                                             purpose of the job
                                           – Fundamental Information Box –
                                              o   Date and times
                                              o   Highlights reporting relationships
                                              o   Records to whom the position is assigned
                                              o   Location of the HCC or position
                                              o   Contact information and radio title
                                                                       JAS Format
Center for HICS Education and Training


                                                                    OPERATIONS SECTION CHIEF

                                         Mission: Develop and implement strategy and tactics to carry out the
                                         objectives established by the Incident Commander. Organize, assign,
                                         and supervise Staging, Medical Care, Infrastructure, Security, Hazardous
                                         Materials, and Business Continuity Branch resources.


                                         Date:             Start:          End:     Position Assigned to:           Initial:

                                         Position Reports to: Incident Commander   Signature:

                                         Hospital Command Center (HCC) Location:                       Telephone:

                                         Fax:                Other Contact Info:                Radio Title:
                                                        JAS Format
Center for HICS Education and Training



                                         • Action Steps and Considerations
                                           – JAS provides position action steps and
                                             considerations
                                         • Actions listed by operational periods
                                           – Immediate           0–2 hours
                                           – Intermediate         2–12 hours
                                           – Extended            Beyond 12 hours
                                           – Demobilization/System Recovery (New)
                                                             JAS Format
Center for HICS Education and Training



                                         • The JAS format enables users to:
                                           – Document each action undertaken with initials
                                           – Record decision and action timeframes
                                         • Many action steps are common to all positions
                                           –   Read the entire JAS
                                           –   Put on position identification
                                           –   Notify your usual supervisor of your HICS position
                                           –   Document using forms
                                           –   Coordinate with other HICS positions
                                           –   Include considerations for shift change report
                                          Immediate Actions – Operations Chief
Center for HICS Education and Training
                                         Immediate (Operational Period 0-2 Hours)                                             Time   Initial
                                         Receive appointment and briefing from the Incident Commander.
                                            Obtain packet containing Operations Section Job Action Sheets.
                                         Read this entire Job Action Sheet and review organization chart (HICS
                                            Form 207). Put on position identification.
                                         Notify your usual supervisor of your HICS assignment.

                                         Determine need to appoint Staging Manager, Branch Directors, and Unit Leaders
                                            in Operations Section; distribute corresponding Job Action Sheets and
                                            position identification. Complete the Branch Assignment List (HICS
                                            Form 204).
                                         Brief Operations Section Branch Directors and Staging Manager on current
                                             situation and incident objectives; develop response strategy and tactics;
                                             outline Section action plan and designate time for next briefing.
                                         Participate in Incident Action Plan preparation, briefings, and meetings as
                                             needed; assist in identifying strategies; determine tactics, work assignments,
                                             and resource requirements.
                                         Obtain information and updates regularly from Operations Section Branch
                                            Directors and Staging Manager; maintain current status of all areas; inform
                                            Situation Unit Leader of status information.
Center for HICS Education and Training     Intermediate Actions – Operations Chief
                                         Intermediate (Operational Period 2-12 Hours)                                       Time   Initial

                                         Communicate regularly with the Incident Commander, Public Information Officer
                                            and Liaison Officer; brief regularly on the status of the Operations Section.

                                         Designate time(s) for briefings and updates with Operations Section leadership
                                            to develop or update the Section action plan.
                                         Initiate the Resource Accounting Record (HICS Form 257) to track
                                             equipment used during the response.
                                         Schedule planning meetings with Branch Directors and Staging Manager to
                                            update the Section action plan and demobilization procedures.
                                         Coordinate patient care treatment standards and case definitions with public
                                            health officials, as appropriate.
                                         Ensure that the Operations Section is adequately staffed and supplied.

                                         Coordinate personnel needs with Labor Pool & Credentialing Unit Leader,
                                            supply and equipment needs with the Supply Unit Leader, projections and
                                            needs with the Planning Section, and financial matters with the
                                            Finance/Administration Section.
                                         Ensure coordination with any assisting or cooperating agency.
Center for HICS Education and Training
                                                 Extended Actions – Operations Chief
                                         Extended (Operational Period Beyond 12 Hours)                                                Time   Initial

                                         Continue to monitor Operations Section personnel’s ability to meet workload demands, staff
                                             health and safety, resource needs and documentation practices.
                                         Continue to maintain the Resource Accounting Record (HICS Form 257) to track
                                             equipment used during the response.
                                         Conduct regular situation briefings with Operations Section Branch Directors and Staging
                                            Manager.
                                         Address issues related to ongoing patient care:
                                          Ongoing patient arrival
                                          Bed availability
                                          Patient transfers
                                          Patient tracking
                                          Staff health and safety
                                          Mental health for patients, families, staff, incident management personnel
                                          Fatality management
                                          Staffing
                                          Staff prophylaxis
                                          Medications
                                          Medical equipment and supplies
                                          Personnel and resource movement through Staging Area
                                          Linkages with the medical community, area hospitals, and other healthcare facilities
                                          Documentation
                                         Upon shift change, brief your replacement on the status of all ongoing
                                            operations, issues, and other relevant incident information.
                                                        Demobilization/System Recovery Actions
                                                                    Operations Chief
Center for HICS Education and Training
                                         Demobilization/System Recovery                                                                  Time   Initial

                                         As needs decrease, return Operations Section staff to their usual jobs and combine
                                             or deactivate positions in a phased manner, in coordination with the Demobilization Unit
                                             Leader.
                                         Coordinate patient care restoration to normal services.

                                         Coordinate final reporting of patient information with external agencies through Liaison
                                             Officer and Public Information Officer.
                                         Work with Planning and Finance/Administration Sections to complete cost data
                                            information.
                                         Debrief staff on lessons learned and procedural/equipment changes needed.

                                         Upon deactivation of your position, brief the Incident Commander on current problems,
                                            outstanding issues, and follow-up requirements.
                                         Upon deactivation of your position, ensure all documentation and Operational Logs
                                            (HICS Form 214) are submitted to the Documentation Unit.
                                         Submit comments to the Incident Commander for discussion and possible inclusion in an
                                            after-action report; topics include:
                                          Review of pertinent position descriptions and operational checklists
                                          Recommendations for procedure changes
                                          Section accomplishments and issues
                                         Participate in stress management and after-action debriefings. Participate in other briefings
                                              and meetings as required.
                                                            JAS Format
Center for HICS Education and Training


                                         • Documents/Tools –
                                           – A listing of pertinent HICS forms this position is
                                             responsible for using
                                              o Forms noted in JAS action steps
                                           – Other tools that will help them fulfill their role
                                             and responsibilities
                                              o Hospital plans, policies and procedures
                                              o Technology tools
                                              o Other adjuncts
Center for HICS Education and Training
                                                      Documents/Tools –
                                                       Operations Chief
                                         Documents/Tools
                                            Incident Action Plan
                                            HICS Form 204 – Branch Assignment Sheet
                                            HICS Form 207 – Organization Chart
                                            HICS Form 213 – Incident Message Form
                                            HICS Form 214 – Operational Log
                                            HICS Form 257 – Resource Accounting Record
                                            Hospital emergency operations plan
                                            Hospital organization chart
                                            Hospital telephone directory
                                            Radio/satellite phone
                                         Role of Deputies and Assistants
Center for HICS Education and Training



                                         • No JAS has been written for a Deputy Chief
                                           or assistants
                                           – They work from the JAS of the position they
                                             assume
                                         • Deputy Chief:
                                           – Assigned for Command or General Staff
                                         • Assistant:
                                           – Assigned for Command or General Staff
                                           – Assigned to Unit Leaders as needed and resources allow
                                                          JAS Use
Center for HICS Education and Training


                                         • The format allows for the JASs to be used
                                           – To preliminarily document actions taken during the
                                             incident
                                           – To develop a chronology of events, problems
                                             encountered, and decisions made

                                         • Use the Operational Log (HICS Form 214)
                                           continuously to detail actions, decisions and
                                           activities
                                                          JAS Use
Center for HICS Education and Training


                                         • JASs are used continuously during the
                                           response
                                           – Actions in all operational periods should be
                                             continued and monitored


                                         • JAS should transfer to your replacement and
                                           actions continued
                                           – Upon shift change or position change
                                               JAS Customization
Center for HICS Education and Training



                                         • The JASs are designed to be customized for
                                           the needs of each hospital
                                           – Hospitals can use the HICS JASs as prepared
                                           – Hospitals can modify the HICS JASs based on:
                                             o Hospital size
                                             o Available resources
                                             o Response needs
                                           – Hospitals can craft their own, unique JAS
                                                  JAS Customization
Center for HICS Education and Training



                                         • Hospitals are encouraged to use the HICS
                                           JAS model as a template for customized JASs
                                           – Maintain the prescribed format and terminology
                                             to ensure the standardization benefit of NIMS
                                           – Modify the Operational Period Actions and
                                             Documents/Tools section appropriately for the
                                             facility and community
                                          JAS Customization Processes
Center for HICS Education and Training



                                         • Review all HICS Job Action Sheets
                                           – Convene subject matter experts and
                                             stakeholders from within institution to review job
                                             action sheets
                                           – Engage persons/staff who would fill those roles
                                             in an event
                                           – Ensure JASs meet hospital needs
                                             o Revise content as necessary with details (e.g. correct
                                               telephone numbers, etc)
                                           – Place own hospital logo on each JAS if desired
                                           JAS Training and Exercising
Center for HICS Education and Training



                                         • JASs should be used in trainings and
                                           exercising
                                           – Enhance familiarity of position description,
                                             mission and actions
                                         • Conduct focused drills with Branches and
                                           Sections to enhance understanding of the
                                           incident management team structure
                                                   Section Summary
Center for HICS Education and Training


                                         • The Job Action Sheets are:
                                           – An incident management tool
                                           – A series of actions to meet the incident response
                                           – Are divided in time phases
                                             o Immediate 0-2 hours
                                             o Intermediate – 2-12 hours
                                             o Extended – Greater than 12 hours
                                             o Demobilization/System Recovery
                                           – Standardized to facilitate interagency response
                                           – Customizable for the unique facility needs/roles
Center for HICS Education and Training

                               Questions?
Center for HICS Education and Training




                   Planning
                Incident Action
Center for HICS Education and Training
                                                  Incident Action Plans
                                         • Incidents Action Plans:
                                            – Provide all IMT personnel with direction for actions based
                                              on the objectives during the operational period**
                                            – Are a means of communicating the overall incident
                                              objectives, including:
                                               o Operational activities
                                               o Support activities
                                            – A tool to successful transition of operational activities to
                                              HCC relief staff
                                         • Incident action planning requires an understanding
                                           the hospital’s policy and direction
                                         • Incident action planning is essential for a successful
                                           response and recovery
                                                   Incident Action Plans
Center for HICS Education and Training


                                         • IAP processes use Management by Objectives
                                           –   Setting the Operational Period
                                           –   Determining overall priorities
                                           –   Establishing specific, measurable, attainable objectives
                                           –   Selecting effective strategies and tactics to accomplish
                                               objectives
                                           –   Identify needed resources
                                           –   Develop and issue assignments
                                           –   Direct, monitor and evaluate response efforts to enhance
                                               response in the next op period
                                           –   Document results
                                           –   Corrective actions
                                             Incident Action Planning
Center for HICS Education and Training



                                         • The IAP covers an Operational Period
                                         • Elements of an IAP
                                           – What must be done
                                           – Who is responsible
                                           – How information is communicated
                                           – What should be done if someone is injured
                                         Incident Action Planning Process
Center for HICS Education and Training


                                         • The Incident Commander sets times for IAP
                                           meetings
                                         • The Section Chiefs develop their Section’s
                                           action plan for the next operational period
                                           – Input from Branch and Unit staff

                                         • Section IAP submitted to Planning Chief
                                           – Assimilated into a single HCC IAP
                                           – Documentation and Situation Unit Leaders
                                             compile the IAP
                                         Incident Action Planning Process
Center for HICS Education and Training



                                         • Incident Action Planning Meeting conducted
                                           by the IC
                                           – Command Staff and General Staff attend the
                                             meeting
                                         • IAP is discussed and modified, as needed
                                         • Next Action Planning Meeting is determined
                                         • IC Approved and final IAP is distributed to
                                           HCC staff
                                           – Distribution by the Documentation Unit Leader
                                            Incident Action Planning
Center for HICS Education and Training



                                         • The IAP should be developed ASAP after the
                                           HCC is operational
                                           – It becomes the preliminary guidance for a
                                             defined, short operational period
                                         • HICS forms to utilize:
                                           – HICS Form   201   –   Incident Briefing
                                           – HICS Form   202   –   Incident Objectives**
                                           – HICS Form   203   –   Organizational Assignment List
                                           – HICS Form   261   –   Incident Action Plan Safety
                                             Analysis
                                                  Section Summary
Center for HICS Education and Training



                                         • The IAP provides all IMT personnel with
                                           direction for actions based on the objectives
                                           during the operational period**
                                         • Incident Action Planning uses the elements of
                                           Management by Objectives
                                         • Incident Action Planning is done by
                                           Command and General Staff
                                         • Incident Action Planning is essential for
                                           effective response and recovery
Center for HICS Education and Training

                               Questions?
Center for HICS Education and Training




                                          Incident Planning Guides
                                                      &
                                         Incident Response Guides
                                            Incident Specific Planning
Center for HICS Education and Training



                                         • During the initial response period, activities
                                           are guided by:
                                           – Emergency Operations Plan
                                           – Incident-specific guides
                                         • These plans/guides assist the IC:
                                           – To conduct a situation assessment
                                           – Set initial objectives
                                           – Establish the HCC/ICS organization
                                                 HICS IPGs and IRGs
Center for HICS Education and Training



                                         • An incident-specific scenario “sets the stage”
                                           for the IPGs and IRGs
                                         • 13 internal scenarios
                                           – Based on most likely internal hospital incidents
                                         • 14 external scenarios
                                           – Based on the Department of Homeland Security
                                             National Planning Scenarios
Center for HICS Education and Training
                                         Incident Planning and Response Guides
                                               Internal Guides                      External Guides
                                           •   Bomb Threat              •   Nuclear Detonation
                                           •   Evacuation               •   Biological attack - Anthrax
                                           •   Fire
                                                                        •   Biological disease outbreak -Pandemic
                                           •   HazMat Spill                 Influenza
                                           •   Hospital Overload
                                                                        •   Biological Attack – Plague
                                           •   Hostage/Barricade
                                                                        •   Chemical Attack – Blister Agent
                                           •   Infant/child abduction
                                                                        •   Chemical Attack – Toxic Industrial Chemicals
                                           •   Internal flooding
                                           •   Loss of HVAC             •   Chemical Attack - Nerve agent
                                           •   Loss of Power            •   Chemical Attack – Chlorine
                                           •   Loss of Water            •   Natural Disaster – Earthquake
                                           •   Severe weather           •   Natural Disaster – Hurricane
                                           •   Work stoppage            •   Radiological Attack – RDD
                                                                        •   Explosives Attack – IED
                                               All-Hazards Guide        •   Biological Attack – Food Contamination
                                                                        •   Cyber Attack
                                                   Introductory Scenario
Center for HICS Education and Training


                                                    Example: Internal Scenario - Fire

                                         Your hospital is in the middle of the annual flu season. It is mid winter and
                                             it is unusually cold outside. The time is 10:30 PM. The hospital inpatient
                                             beds are at 95% capacity and there are patients holding in the ED to be
                                             admitted.
                                         A fire has broken out and has engulfed the laboratory area, and the fire
                                             sprinkler system in that area has activated. The fire department quickly
                                             responds and extinguishes the fire before it can spread beyond the
                                             laboratory area. The fire department assists with the smoke and water
                                             removal.
                                         Two staff members from the laboratory are injured with burns and smoke
                                             inhalation, one seriously and one in critical condition. The lab is totally
                                             destroyed and is unusable. The extensive smoke and water damage has
                                             spread to the ICU and the patient rooms above the lab. The staff are
                                             asking if they should evacuate the hospital. The local press is now on
                                             scene and is demanding information and access to the hospital.
                                                      IPGs and IRGs
Center for HICS Education and Training



                                         • Hospitals use these incident-specific guides
                                           – According to the facility HVA
                                           – The community HVA
                                         • Additional IRGs and IPGs may need to be
                                           developed by the facility to address a hazard
Center for HICS Education and Training




                      Incident
                  Planning Guides
                                             Incident Planning Guides
Center for HICS Education and Training


                                         • Incident Planning Guides
                                           – Outline strategic planning considerations for
                                             incident-specific situations
                                           – Formatted to the emergency management
                                             phases
                                             o Mitigation (including prevention)
                                             o Preparedness
                                             o Response
                                             o Recovery
                                           – Used to evaluate the facility’s Emergency
                                             Operations Plan
                                           – Used to develop Incident Response Guides
                                                     IPG: Example - Fire
Center for HICS Education and Training


                                         Does your Emergency Management Plan Address the following
                                           issues?
                                         Mitigation & Preparedness
                                                   Does the fire alarm and overhead announcement sound loudly enough
                                                     to be heard in all locations?
                                                   Does the fire alarm system include both audible and visual systems
                                                     (e.g. alarm tone and flashing strobe lights)?

                                                   Does the hospital have lighted emergency exits in all areas?

                                                   Does the fire alarm automatically notify the local fire department?

                                                   Does the hospital have a fire plan that includes closing and securing all
                                                     doors and windows?
                                                   Does the hospital have procedures to immediately shut off valves that
                                                     control oxygen and other gases?
Center for HICS Education and Training




               Guides
              Incident
              Response
                                            Incident Response Guides
Center for HICS Education and Training


                                         • Incident Response Guides
                                           – Are incident-specific
                                           – Are activated during response
                                           – Provide critical considerations and actions for the
                                             Command and General Staff
                                           – Are time based:
                                              o Immediate – 0-2 hours
                                              o Intermediate – 2-12 hours
                                              o Extended – Greater than 12 hours
                                              o Demobilization/System Recovery
                                            Incident Response Guides
Center for HICS Education and Training



                                         • Should complement
                                           – Emergency Operations Plan
                                             o They complement the EOP but not replace the EOP
                                           – Job Action Sheets

                                         • Can be used as initial documentation
                                                      IRG – Example: Fire
Center for HICS Education and Training

                                             Mission: To reduce the loss of life and property during an
                                             internal fire incident.
                                         Directions
                                         □
                                              Read this entire response guide and review incident
                                              management team chart
                                         □
                                              Use this response guide as a checklist to ensure all tasks
                                              are addressed and completed

                                         Objectives
                                         □ Confine the fire/reduce the spread of the fire

                                         □    Rescue and protect patients and staff
                                         □    Implement internal emergency management plan – fire
                                                    IRG – Example: Fire
Center for HICS Education and Training


                                         Immediate Actions (Operational Period 0-2 Hours)
                                             COMMAND
                                             (Incident Commander):
                                             -- Activate the facility emergency operations plan and the Incident
                                                Command structure
                                             -- Appoint Command Staff and Section Chiefs
                                             -- Consider the formation of a unified command with hospital and fire
                                                officials
                                         □
                                             -- Determine need for and type of evacuation
                                             (PIO):
                                             -- Establish a media staging area
                                             -- Conduct regular media briefings to update situation status and
                                                provide appropriate patient and employee information
                                             -- Oversee patient family notifications of incident and
                                                evacuation/relocation, if ordered
                                                      IRGs and IPGs
Center for HICS Education and Training



                                         • Uses of the Guides
                                           – To evaluate the EOP
                                           – A training tool
                                           – Tabletop exercises
                                           – As a planning basis for a functional exercise

                                         • Guides will promote more immediate and
                                           higher quality decision-making
                                              JAS versus IRGs & IPGs
Center for HICS Education and Training



                                         • The IRGs are not intended to be a
                                           replacement for Job Action Sheets
                                           – IRGs
                                             o Overview position actions and decision making
                                             o Are Incident Specific
                                           – JASs
                                             o Detail position actions, decisions and activities
                                             o Are all-hazards focused
                                                    Section Summary
Center for HICS Education and Training



                                         • IPGs and IRGs
                                           – Are incident-specific tools to assist hospitals with
                                             planning, training and response/recovery efforts
                                           – Assist in meeting regulatory requirements
                                           – Guide Command and General Staff with decision-
                                             making and action-taking
                                           – Should be consistent with the EOP
                                           – Do not replace the JAS
Center for HICS Education and Training

                               Questions?
Center for HICS Education and Training




                HICS Forms
                                                  Using the HICS Forms
Center for HICS Education and Training



                                         • Purpose:
                                           – To provide the incident management team with
                                             the documents needed to manage a response
                                         • Use:
                                           – Each form has a specific purpose identified at the
                                             bottom of the form
                                           – Instruction sheets for each form can be printed
                                             on reverse side of each form, if desired

                                         • Forms have been modified from existing
                                           FEMA ICS forms for use in hospitals
                                            Value of Using HICS Forms
Center for HICS Education and Training



                                         • Your facility will be consistent with other
                                           healthcare facilities and community
                                           responders

                                         • Information can be more easily shared
                                           among all responders

                                         • Documentation guides your response and
                                           assists in your recovery efforts
                                           Value of Using HICS Forms
Center for HICS Education and Training



                                         • Serves as a road map in response: everyone
                                           acting from the same plan
                                         • Serves as a foundation for corrective action
                                         • Ensures consistency and compliance with
                                           regulatory guidelines

                                         • Complies with NIMS Publications
                                           Management Standard*
                                                  Using the HICS Forms
Center for HICS Education and Training


                                         • Forms format includes:
                                           –   Form number
                                           –   Name of form
                                           –   Who is responsible for completion
                                           –   When form is to be completed
                                         • 20 HICS forms
                                           – Found in the Guidebook Appendix D
                                         • Utilize current facility forms + HICS forms for
                                           response
                                         • Develop additional forms to meet the
                                           incidents
Center for HICS Education and Training
                                                   Using HICS Forms
                                         • Appropriate HICS forms completed by each
                                           HCC position
                                           – Forms can be done electronically or hand-written
                                           – Write legibly and clearly
                                           – Complete all areas on the form
                                         • Completed forms distributed with a copy to
                                           the Planning Section
                                           – Forms will be archived to document response
                                         • Forms and other incident documentation
                                           used to craft the AAR
                                                            HICS Forms
Center for HICS Education and Training


                                          No.                 Name                      Responsible
                                         201    Incident Briefing                Incident Commander
                                         202    Incident Objectives              Section Chiefs
                                         203    Organizational Assignment List   Resource Unit Leader
                                         204    Branch Assignment List           Branch Directors
                                         205    Communications Log               Communications Unit Leader
                                         206    Staff Medical Plan               Support Branch Director
                                         207    Organization Chart               Incident Commander
                                         213    Incident Message Form            All Positions
                                         214    Operational Log                  Command Staff and General
                                                                                 Staff
                                         251    Facility System Status Report    Infrastructure Branch
                                                                                 Director
                                          No.                 Name                             Responsible
Center for HICS Education and Training

                                         252    Section Personnel Time Sheet           Section Chiefs

                                         253    Volunteer Staff Registration           Labor Pool & Credentailiting Unit
                                                                                       Leader
                                         254    Disaster Victim / Pt Tracking Form     Patient Tracking Manager

                                         255    Master Pt Evacuation Tracking Form     Patient Tracking Manager

                                         256    Procurement Summary Report             Procurement Unit Leader

                                         257    Resource Accounting Record             Section Chiefs

                                         258    Hospital Resource Directory            Resource Unit Leader

                                         259    Hospital Casualty / Fatality Report    Patient Tracking Manager

                                         260    Patient Evacuation Tracking Form       Inpt Unit Leader Outpt Unit
                                                                                       Leader, Casualty Care Unit Leader

                                         261    Incident Action Plan Safety Analysis   Safety Officer
Center for HICS Education and Training
                                          HICS 201 – Incident Briefing
                                         • Purpose
                                           – Documents initial response information and
                                             actions taken at start-up
                                         • Origination
                                           – Incident Commander
                                         • Copies to
                                           – Command staff, Section Chiefs, and
                                             Documentation Unit Leader
                                         • When to Complete
                                           – Prior to briefing the current operational period
                                         • Helpful Tips
                                           – Distribute to all staff before initial briefing
                                            HICS 201 – Incident Briefing
Center for HICS Education and Training



                                         • Instructions
                                           – Print legibly and enter complete information
                                              o Incident Name
                                              o Date of briefing
                                              o Time of Briefing
                                              o Event History and Current Actions Taken
                                              o Current Organization
                                              o Notes (warnings, directives, etc.)
                                              o Prepared by (name and position)
                                              o Facility Name
Center for HICS Education and Training
Center for HICS Education and Training
Center for HICS Education and Training
                                              Lab/West Wing Fire                                  2-27-06                          0800


                                         Fire broke out at 7:00 am in the main laboratory on the 2nd floor. Large amount of
                                         smoke with foul odor. Fire sprinklers activated.


                                         0705 HCC activated. EOP activated. Fire department enroute. Positions activated: Safety
                                         Officer, Operations Chief, Infrastructure Branch Director and Medical Care Branch Director




                                          0800 Fire department arrived and unified command established.




                                         Evacuation of patient care areas near the lab in progress. All depts instructed to send
                                         casualty reports to HCC.
Center for HICS Education and Training
                                                                       J. Smith




                                                     B. Walters                   L. Henson



                                                      A. Doe




                                         C. Barton                N. DeGuzman      R. O’Reilly
                                                                                                 A. Greenspan
Center for HICS Education and Training
                                           HICS 202 – Incident Objectives
                                         • Purpose
                                           – Defines objectives and issues for operational period
                                         • Origination
                                           – Planning Section Chief
                                         • Copies to
                                           – Command staff, General Staff and Documentation Unit
                                             Leader
                                         • When to Complete
                                           – Prior to briefing the current operational period
                                         • Helpful Tips
                                           – Serves as a roadmap to incident management
                                           HICS 202 – Incident Objectives
Center for HICS Education and Training

                                         • Instructions
                                           – Print legibly and enter complete information
                                              o Incident Name
                                              o Date prepared
                                              o Time prepared
                                              o Operational Period Date and Time
                                              o General Command and Control Objectives for the
                                                Incident
                                              o Weather / Environmental Implications for the Period
                                              o General Safety / Safety Messages
                                              o Attachments
                                              o Prepared by (Planning Chief: use proper name)
                                              o Approved by (Incident Commander)
                                              o Facility Name
Center for HICS Education and Training
Center for HICS Education and Training

                                            Lab/West Wing Fire

                                                   2-27-07                                   0800                              2-27-07 0800 - 1500



                                             1.    Ensure communications links to Fire Department, community hospitals and
                                                   emergency operations center are functioning

                                            2.    Initiate structural assessment of hospital

                                            3.    Assess injuries to patients, visitors and staff

                                            4.    Establish alternate care sites as needed for patient evacuations




                                         Winds from NE at 12 mph. Low fog remains, expected to dissipate by 1100. Temperatures currently 41 degrees; high of
                                         55 expected with overnight temps to high 30’s. Rain forecast by weekend.
                                                    HICS 203: Organization Assignment List
Center for HICS Education and Training

                                         Lab/West Wing Fire
                                         2-27-07              0900                 0800-1500

                                                                 J Smith
                                                                 Barbara Walters
                                                                 L. Henson
                                                                Jane Doe




                                                                Clara Barton
Center for HICS Education and Training    HICS 203: Organization Assignment List

                                           Radar O’Reilly




                                         John Q. Public
Center for HICS Education and Training
                                     HICS Form 204: Branch Assignment List
Center for HICS Education and Training
                                    HICS Form 204: Branch Assignment List
Center for HICS Education and Training      HICS Form 213: Incident Message Form


                                         C Barton, Operations                        R. O’Reilly, Logistics

                                         2-27-07    1000




                                         Call from the laboratory manager. States that the lab will not be functional due
                                         to major equipment damage from heat and smoke. Laboratory non-functional.
                                         Request transportation of stat lab specimens to the community laboratory for
                                         testing.
Center for HICS Education and Training       HICS Form 213: Incident Message Form
                                          Community Laboratory called and will accept specimens and blood tubes
                                          for testing. Transporation van will pick up specimens and transport to the
                                          community lab at 1200.




                                         IMA Vampire                                            1100
                                                                        HICS Form 214
Center for HICS Education and Training
                                         Lab/West Wing Fire
                                            2-27-07                          2-27-07 0800-1500
                                         Operations, Medical Care Branch

                                         0820              Position Activated and situation briefing obtained

                                         0900              West Unit patient care unit with major smoke damage. Patients with
                                                           respiratory symptoms and anxiety. Ordered evacuation of the wing




                                          Clara Barton
                                                                       HICS Form 254
Center for HICS Education and Training

                                         Lab/West Wing Fire              2-27-07       2-27-07 0800-1500



                                         2135   Brad Pitt     M   34     ED             1200   Transfer    1230
Center for HICS Education and Training   HICS Form 255
Center for HICS Education and Training
                                         HICS Form 257
Center for HICS Education and Training   HICS Form 258
Center for HICS Education and Training   HICS Form 258
Center for HICS Education and Training
                                         HICS Form 258
Center for HICS Education and Training   HICS Form 261
                                                  Section Summary
Center for HICS Education and Training


                                         • The HICS forms:
                                           – Provide the Incident Management Team with the
                                             documents needed to manage a response
                                           – Assist in communication with external agencies
                                             and resources
                                           – Assist in communication with hospital staff
                                           – Provide documentation for response and recovery
                                             activities
Center for HICS Education and Training

                               Questions?
                                                 Summary of the Day
Center for HICS Education and Training


                                         • Today we have learned about:
                                           – NIMS and ICS concepts and principles
                                           – NIMS Implementation Activities for Hospitals
                                           – The origins of HICS
                                           – The Hospital Incident Command System
                                             o Incident Management Team
                                             o Command and General Staff
                                             o All HICS positions
                                                Summary of the Day
Center for HICS Education and Training



                                         • Today we learned about:
                                           – The importance of Incident Action Planning
                                           – HICS Materials
                                             o Job Action Sheets
                                             o Incident Planning and Response Guides
                                             o Forms
                                         Evaluation of the Day
Center for HICS Education and Training




                                         How was the course
                                             so far????
                                                Agenda for Tomorrow
Center for HICS Education and Training


                                         • We will be discussing:
                                           – Community response relationships
                                           – HICS for rural and small facilities
                                           – Strategies for HICS implementation in hospitals
                                         • We will be conducting:
                                           – Small group facilitated tabletop exercises
                                         • You will be taking:
                                           – A post-test
                                              o For HICS course certification
                                              o For ICS 100 and 200/IS 700 course completion
Center for HICS Education and Training

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:10
posted:5/15/2012
language:English
pages:352
fanzhongqing fanzhongqing http://
About